November 04, 2021

Texas Medical Association Files Surprise Billing Rule Suit

The Texas Medical Association (TMA) filed suit Oct. 29, asking the U.S. District Court for the Eastern District of Texas to strike the independent dispute resolution (IDR) section of the Biden administration’s interim final rule (IFR) to implement the No Surprises Act. TMA asserts that the rule ignores statutory text and congressional intent of the act and asks the court to restore the fair, balanced IDR process that Congress created. Congress passed the Surprise Billing Act to restrict excessive out-of-pocket costs to consumers from surprise billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan's network and can happen for both emergency and non-emergency care.

The TMA lawsuit echoes several of the objections the American College of Radiology® (ACR®) Board of Chancellors Chair Howard Fleishon, MD, FACR, made shortly after the release of the IFR. Dr. Fleishon stated, “This rule violates the intent, if not the actual letter, of the No Surprises Act and shatters a rare bipartisan, industry-wide agreement for equitable provider-insurer dispute resolution.”

The College is currently drafting comments in response to the IFR to convince the U.S. Departments of Health and Human Services, Treasury and Labor to alter their interpretation of the IDR section of the No Surprises Act. In addition, the ACR and other medical associations, including the American Medical Association, are considering other avenues to ensure the IDR section of the rule is revised to accurately reflect congressional intent, including filing or joining a lawsuit. Prior to the ACR determining its level of participation/commitment in any legal action, several essential factors — such as the basis for legal argument, the jurisdictional venue and additional plaintiffs — would need to be considered.

The ACR also is working with U.S. Reps. Suozzi (D-NY), Wenstrup (R-OH), Ruiz (D-CA) and Bucshon (R-IN), who are encouraging their House colleagues to sign on to a letter to the secretaries of the respective federal agencies objecting to the rule’s interpretation of IDR. To date, 118 bipartisan members of the House of Representatives have agreed to sign. The ACR sent several Calls to Action to members asking them to urge their representative to cosign the Suozzi, Wenstrup, Ruiz, Bucshon letter.

The College will continue to provide updates on efforts to revise the IDR interpretation to more accurately reflect congressional intent.

For more information, contact Josh Cooper, ACR Vice President of Government Relations and Economics Health Policy