Physicians Defeat No Surprises Act Arbitration Bill
Late last month, the Arizona House Appropriations Committee heard House Bill 2211 , which would have given health insurers an advantage in No Surprises Act arbitration by introducing two new caps on what a physician or other healthcare practitioner may offer:
- 300% of the approved Medicare reimbursement rate, or
- 300% of the qualifying payment amount
A violation of the statute would have been considered unprofessional conduct and could have threatened a physician's license.
Thanks to a swift and coordinated response from the healthcare community, the bill was stopped in its tracks and is not expected to re-appear during this year's legislative session.
Background on NSA Arbitration & Latest Trends
The proponent of the bill claimed that the Independent Dispute Resolution (IDR) process has turned into a "jackpot" for clinicians, however, this is not the reality. For example, the American Hospital Association cites federal data showing that Anthem does not participate in 30% of disputes, and the increase in clinicians prevailing in IDR from 2023-2024 (80-85%) was largely attributable to default decisions, especially in Q4 of 2024.
Tying "provider offers" to the Qualifying Payment Amount (which is determined by insurers) or the Medicare rate would give physicians and other clinicians a deeply unfair disadvantage in negotiations.
To make matters more frustrating, physicians are not being paid in a timely fashion when they prevail in disputes. A recent survey from the Emergency Department Practice Management Association (EDPMA) found that nearly 60% of IDR decisions in favor of emergency physicians had not been paid under the statutory requirements. A broader survey of clinicians across 45 states found that 22% of IDR awards owed in 2023 and 11% of awards owed in 2024 had not been paid at all.
ArMA, Others Coordinate Swift Response
The health care community, including the Arizona Medical Association and the Arizona Hospital Association, was united in opposition. The bill did not receive a vote in committee, meaning it was successfully stopped from moving forward in the legislative process this year.
ArMA's Advocacy Team continues to monitor this and other issues most pressing to Arizona physicians and their patients. To learn more about our efforts, visit our webpage.
