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- No Surprises Act Court Ruling Favors Physicians on Independent Dispute Resolution Process
Circuit Court judges on August 6 upheld a 2023 ruling that vacated parts of the federal government’s regulations implementing the independent dispute resolution (IDR) process under the No Surprises Act. Specifically, the Circuit Court upholds the decision that the government’s regulations had improperly weighted the qualifying payment amount (QPA) during IDR determinations.
In September 2022, the Texas Medical Association sued the Department of Health and Human Services (HHS) arguing that a provision in the No Surprises Act final rule unfairly favored insurance companies. The lawsuit argued that during payment disputes between providers and insurance companies, independent arbiters were to first consider the insurer-set QPA when deciding a payment amount for providers. The regulations also placed greater weight on the QPA compared to other factors due to a flawed “double counting” prohibition. The CAP had also identified these issues and called on the federal government to change its rules. In February 2023, a district court judge agreed with the Texas Medical Association and struck down the problematic portions of the regulations.
On August 6, the Circuit Court judges confirmed that this framework conflicted with the goals of the No Surprises Act and also ruled in favor of the Texas Medical Association. Because the regulations in question were previously struck down by the lower court decision, the IDR process will continue as is, without weighting the QPA more heavily than any other factor. Future rulemaking on this issue is expected, and it is unclear what further actions the government will take. The CAP will notify members of any further developments.