APA’s Government, Policy, and Advocacy Update (November 2021)

Surprise Billing Rules Yield to Insurers, Draw Ire From Physicians

Physician organizations, including APA, are concerned about the way the Biden administration is implementing the No Surprises Act. The law is set to take effect January 1 and aims to protect patients from unexpected bills that arise when out-of-network clinicians provide emergency or other services at an in-network facility.

The problem of surprise billing has gotten worse in the past decade because health plans have narrowed their networks of clinicians, APA asserted in comments filed in September with the Centers for Medicare and Medicaid Services (CMS) on the law’s Part 1 proposed rule (CMS-9909-IFC). APA expressed concern that the law could have unintended results: By increasing financial stress for inpatient psychiatric units, it could hasten the loss of beds when demand is rising, and there is a growing shortage of psychiatrists.

In its comments, APA urged the following:

• A requirement that insurers create adequate networks of clinicians to treat mental and substance use disorders—in accordance with the Mental Health Parity and Addiction Equity Act.

• A requirement that insurers streamline the approval process for joining a network panel to no more than 30 days.

According to the Part 2 interim final rule (RIN 1210-AB00) that CMS issued in September, in the event of a surprise medical bill, the amount of the bill will be determined by the insurance plan’s median in-network rates for a similar service.

The AMA criticized the rule for disregarding the insurance industry’s role in creating the problem of surprise billing at the expense of independent physician practices. It urged the Biden administration to delay implementation and re-evaluate the rule.

APA: Medicare Patients Need Telehealth, Audio-Only Care Access

APA urged the Biden administration to reconsider a proposed rule (CMS-1751-P) that would require clinicians to see Medicare patients for an in-person appointment to be eligible for any telehealth encounter.

The changes that CMS put in place during the pandemic “showed the potential and benefits of virtual care in meeting treatment needs, including reduced no-show rates for appointments, increased continuity of care, and increased patient satisfaction,” APA wrote in formal comments submitted to CMS in September. However, the proposed requirement for an in-person appointment either initially or for subsequent visits for Medicare enrollees could dilute the benefits of easily accessed telehealth and erect barriers to care.

APA also recommended that CMS continue to allow audio-only telehealth services for Medicare enrollees on a permanent basis. Putting restrictions on audio-only care will disproportionately affect individuals who are low-income; elderly; or are without transportation, reliable access to broadband, or personal electronic devices.

Coalition States Mississippi Abortion Law Harms Doctor-Patient Relationship

APA joined a coalition of 25 health care organizations urging the U.S. Supreme Court to overturn Mississippi’s ban on abortion after 15 weeks of pregnancy for nearly all patients, according to an amicus brief filed in September in the case Dobbs v. Jackson Women’s Health Organization.

The brief asserts that the state law grossly interferes in the patient-clinician relationship and is fundamentally at odds with scientific evidence, medical ethics, and the provision of safe and essential health care. The organizations further argue that the law would have a disproportionate impact on rural and low-income individuals and those from communities of color.

Mississippi’s law was blocked by lower courts from taking effect, but the U.S. Supreme Court will hear the case starting December 1. The case is a direct challenge to Roe v. Wade, testing whether a law that bans abortion previability is unconstitutional. (Twelve states, including Mississippi, have abortion trigger laws on the books that will automatically ban abortion in the first and second trimester if Roe v. Wade is overturned.)

Meanwhile as of press time, a near-total abortion ban in Texas will continue to be enforced, pending an expected appeal to the Supreme Court. A panel of judges from the U.S. Court of Appeals for the Fifth Circuit sided against a Justice Department request to lift the ban. APA, as part of a coalition of leading medical societies, had urged the Fifth Circuit in an amicus brief to uphold a lower court ruling temporarily halting the abortion ban, which gave providers a 48-hour reprieve from the ban. ■