Key Provision of ‘No Surprises Act’ Put on Hold

A ruling from the U.S. District Courts for the Eastern District of Texas has prompted The Centers for Medicare & Medicaid Services (CMS) to temporarily suspend any decisions made by independent dispute resolution (IDR) entities.

The District Court order affects the independent dispute resolution process regarding payment disputes. The Texas Medical Association and other parties had filed the lawsuit due to the Final Rule issued under the No Surprises Act.

According to that order, the Final Rule “governs the arbitration process for resolving payment disputes between certain out-of-network providers and group health plans and health insurance issuers.” The Texas Medical Association and other parties had argued that the provisions of the Final Rule “improperly restrict arbitrators’ discretion and unlawfully tilt the arbitration process in favor of the QPA [qualifying payment amount].”

The Court agreed.

After the Court issued its opinion, CMS responded by saying: “As a result of the TMA II decision, the Departments are in the process of evaluating and updating Federal IDR process guidance, systems, and related documents to make them consistent with the TMA II decision. Effective immediately, certified IDR entities should not issue new payment determinations until receiving further guidance from the Departments. Certified IDR entities also should recall any payment determinations issued on or after February 6, 2023. Certified IDR entities should continue working through other parts of the IDR process as they wait for additional direction from the Departments.”

The Texas Medical Association, which has already filed four lawsuits is not holding back when voicing opposition to portions of the No Surprises Act. Most recently, the Texas Medical Association, joined by others, filed a lawsuit challenging a 600% increase in administrative fees for dispute resolution. For OTW’s coverage of the litigation, see “Texas Docs Sue Over No-Surprises-Act 600% Fee Increase.”