AAMS: New Air Medical Reimbursement Rules Are Unfair

 - November 16, 2021, 11:13 AM

The Association of Air Medical Services (AAMS) has filed a lawsuit in federal court challenging interim final regulations implementing the No Surprises Act, which was passed late last year by Congress as part of a federal omnibus stimulus package and was due to take effect on January 1. It provides a variety of consumer medical protections, including a prohibition on “surprise” billing for out-of-network and emergency medical services that often can saddle patients with enormous unreimbursed medical costs and trigger personal bankruptcies.

While AAMS said it supports the goals of the act, it maintains the interim regulations are skewed to favor medical insurers to the disadvantage of air ambulance providers, which in many cases already provide air medical transport for reimbursement rates below costs. AAMS charges the regulations as currently drafted will only make this situation worse.   

“The fair and transparent process that we all supported [in the act] is not the process being implemented,” charged AAMS president and CEO Cameron Curtis. “Instead, we are faced with a scenario in which a patient is in an emergency, is transported by a helicopter at the request of a trained first responder or qualified physician, and that patient’s insurer gets to unilaterally determine the amount they pay. This will have disastrous consequences for access to emergency air ambulance services.”

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. 

The act provides an independent billing dispute resolution (IDR) process for insurers and medical service providers that forces negotiation between the two. If the matter still cannot be resolved, then it would proceed to an independent third party for settlement charged with deciding the dispute based on a variety of statutory factors. “It was the intent of Congress when passing this law that no single statutory factor receives special weight in the IDR process,” AAMS noted. But the implementation regulations do otherwise, it said.

Specifically, AAMS maintains that the interim regulations "issued by the Departments of Labor, Treasury, and Health and Human Services ignore Congress’s intent, instead focusing on a single factor—the Qualified Payment Amount (QPA) or the insurer’s median in-network rate for only a subset of their contracts for a given service in each area. The QPA is to be the overriding factor in this decision-making process. This means that insurers will be able to know exactly how the IDR entities will resolve these disputes, making the IDR and the open negotiation that precedes it a forgone conclusion. Insurers will also leverage that QPA against future payments, lowering all payments, both in-and-out-of-network, over time.”