November 16, 2022

No Surprises Act Legal Update: The Government Files Back

‘You haven’t proven any harm to physicians, and we have the authority to do what we did,’ asserted the federal government — the U.S. Departments of Health and Human Services, Labor and Treasury, and the U.S. Office of Personnel Management — last week in its response to the Texas Medical Association (TMA) lawsuit regarding implementation of the No Surprises Act (NSA). The American College of Radiology® (ACR®), the American Society of Anesthesiologists and the American College of Emergency Physicians supports TMA in this case as an amicus or friend of the court. The ACR, ACEP and ASA charge that the final rule released by the government to implement the NSA in August skews the independent dispute resolution (IDR) process to favor the insurer-calculated qualifying payment amount (QPA) over other factors Congress specifically directed IDR arbitrators to consider equally.

The government submitted a cross motion for summary judgment in Texas federal court regarding the TMA suit Nov. 9. The government requests that the judge grant its motion to dismiss the lawsuit because TMA allegedly fails to show that it has standing or the legal right to file one to challenge the IDR process.

Additionally, the government asserts that it lawfully applied its regulatory authority to publish an NSA final rule in August. The government used that authority to “reasonably” instruct arbitrators to apply consistent criteria in selecting the offer (from a physician or insurer) that best fits the value of the qualified IDR item or service.

TMA has the next legal move, as it may reply to the government’s motion by Nov. 23. The court then will hold a hearing Dec. 20 and may decide this matter by January.

For more information, contact Tom Hoffman, ACR Vice President, Legal.