No Surprises Act Rejected in Texas Court

From ACG Legislative and Public Policy Council Chair, Louis J. Wilson, MD, FACG

On Wednesday evening, a federal judge for the Eastern District of Texas ruled in favor of the Texas Medical Association’s challenge to the federal No Surprises Act.

The No Surprises Act became effective on January 1, 2022, but the rules related to the independent dispute resolution (IDR) process have been at issue after the federal government released rules that many organizations (including ACG) believe are inconsistent with the legislation.

The court agreed, finding that the "Act is unambiguous when providing directives to regulators, thus must be held unlawful and set aside on this basis alone." On the procedural issues, the court further found that the federal government lacked cause to bypass notice and comment rulemaking. Read the court's decision here. There are similar cases pending in other federal courts, including two in the District Court for the District of Columbia. Those cases were not filed as early as the TMA case.

The U.S. House Ways & Means Committee Democratic and Republican leadership both supported the ruling in a press release. ACG and a coalition like-minded organizations are urging Congress to help reform these surprise billing rules. Recently, ACG members were instrumental in garnering support for a bipartisan congressional letter to the Biden Administration, demanding that these rules reflect the law as passed. Click here for the press release from U.S. Representative Brad Wenstrup, D.P.M. (R-OH), which includes a quote from ACG President Samir Shah, MD, FACG.

Please note: The Texas ruling affects only the challenged aspects of IDR rules and process, not the law in its entirety.

ACG Guidance: The No Surprises Act prohibits certain out-of-network patient billing. The law also requires practices to provide a "Good Faith Estimate" for services. Is your practice prepared? What do GI practices need to know about these "Good Faith Estimate" rules for all uninsured and self-paying patients? ACG has developed guidance and provides the template forms for you.

CDC Updates Mask Guidance

The Centers for Disease Control and Prevention (CDC) announced new masking guidelines on Friday. Under the new guidance, 70% of the U.S. would be in a location with low or medium COVID-19 levels. For those areas, there is no recommendation for indoor masking unless the person is at an increased risk, and after consultation with the healthcare provider.

The New York Times reported on Sunday that the CDC was withholding certain data reported by the states and hospitals. Researchers and epidemiologists note that the CDC is faced with the daunting task of compiling various data-sets from the states in order to publish reliable and accurate information. Yet, they also note that the omission of publicly available data can lead to misinterpretation. The CDC has subsequently released some of these data.

ACG Survey on Prior Authorization: Harming Patients and GI Practices

ACG Prior Authorization Survey: Click here for the ACG Prior Authorization Advocacy One-Pager. Please share and help bring attention to these dangerous trends limiting access to care and impinging the patient-physician relationship. Prior authorization is harming patients and GI practices!

Patient Stories Showing Harm and Adverse Events from Prior Authorization: Please encourage your patients to contact ACG about their experiences with prior authorization and the impact to their care. ACG is collating these stories for meetings with legislators and hopes to bring the power of patient voices to these discussions.

ACG E-MAGAZINE: 2022 ACG Practice Management Toolbox Highlights