NEW! ADMINISTRATIVE ACTIONS TO PRESERVE PATIENT ACCESS TO CRITICAL AIR AMBULANCE SERVICES: Health Insurance Payor Behavior and the QPA Presumption for Air Ambulance Services
AAMS submits letter, dated July 11, to the Office of Management and Budget (OBM) with recommendations for NSA Final Rule Implementation.
The No Surprises Act was a bill passed at the beginning of 2022 to protect individuals from receiving surprise medical bills in most cases. In short, Americans will no longer be held liable for out-of-network costs outside of their control.
AAMS fully supports the elimination of surprise billing for patients using out-of-network services. However, the language in the bill that addresses the implementation of the Independent Dispute Resolution (IDR) process is problematic for air medical providers. As written, IDR entities, tasked with mediation between the air medical provider and the insurance company, are to use a median rate of the insurance company to decide the amount that will be paid to the provider, otherwise known as the Qualifying Payment Amount (QPA). If the QPA is the primary factor in the consideration of the final amount due to the provider, it fails to take into account the multiple cost factors that affect a medevac transport including the cost of the clinicians, fuel and mileage rates, and different geographic regions. By excluding these other factors, the QPA becomes artificially depressed, leaving air ambulance companies without enough compensation to keep their operations viable.
In November of 2021, AAMS filed a lawsuit in federal court challenging interim final regulations (IFRs) implementing the No Surprises Act, most notably the focus on a single factor - the Qualified Payment Amount (QPA) - in the mediation process. AAMS believes that a fair process in which all factors - including the type of aircraft, the quality of the services provided, and the acuity of the patient, among others - are considered when deciding a payment dispute can ensure the sustainability of air medical services and the larger healthcare system.
NSA In Recent News
NSA Resources
NSA Litigation Timeline
September 2021
- The Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (collectively the Departments) release interim final rule (IFR) entitled “Requirements Related to Surprise Billing; Part II." (09/30/21)
October/November Fall 2021
- The Texas Medical Association filed the first lawsuit a filed the first lawsuit arguing that the provisions of IFR Part II that make the qualified payment amount (QPA) the presumptive factor in the IDR process are contrary to law and therefore violate
the Administrative Procedure Act (APA). (10/28/21)
- The AAMS NSA Task Force, formed by the AAMS Board of Directors, recommends that AAMS enter litigation concerning both IFR II, arguing that the QPA should not be the presumptive rate and that the methodology for calculating the QPA is flawed. The AAMS
Board approves, and the lawsuit is filed 11/16/21.
December 2021
- The American Medical Association (AMA) and the American Hospital Association (AHA) jointly file similar suit challenging the IFR Part II presumption in the IDR. (12/09/21)
- American Society of Anesthesiologists (ASA), American College of Physicians (ACEP) and American College of Radiology (ACR) jointly file similar suit challenging the IFR II implementation of the No Surprises Act. (12/22/21)
February 2022
- In the TMA case in Tyler, TX, Judge Kernoodle rules in favor of TMA and vacates rules related to QPA presumption for healthcare providers; some rules relating to Air Ambulances remain (though those rules reference vacated rules, making the remaining
language ambiguous). (02/23/22)
- The Federal judge presiding over the AAMS and AHA/AMA lawsuits consolidates those cases; AAMS is the lead plaintiff in the case. (02/02/22)
March 2022
- Oral Arguments in AAMS/AMA/AHA Case. Judge Leon indicated an unwillingness to write a decision until 1.) the Government decides to file an appeal in the TMA case, and 2.) the Government publishes a final rule on NSA implementation. AAMS/AMA/AHA all
argue in subsequent briefs for a decision as soon as possible. Government’s filing indicates that the Final Rule will be released in “early summer”.
April 2022
- CMS Releases further IDR guidance indicating that the QPA is still the presumptive factor in IDR decisions for Air Ambulances, not for the rest of healthcare. AAMS asks for reconsideration of this guidance and is denied. (04/08/22)
- AAMS files a Notice of Supplemental Authority informing Judge Leon of the continuance of the QPA presumption in IDR. (04/12/22)
May 2022
- AAMS/AMA/AHA Continue to await a decision in AAMS vs. Becerra. In oral arguments the Judge indicated he wished to wait for two things:
- The first was the Governments appeal in TMA- which they did on 04/22. However, CMS’ guidance on the continued QPA Presumption for air ambulance would nullify the need to wait for an appeal in TMA, as would our IFR 1 arguments- neither of which are
affected by TMA.
- The second hurdle is the Final Rule, now slated for “early summer”. Note that we also opposed waiting on this rule for a decision in our case due to the continued harm the presumption does to our members, as our filing of 05/02/22 indicates.
