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ACR to Continue Judicial Advocacy in No Surprises Act Lawsuits
July 20, 2023
The federal government filed its opening appellate brief July 12 with the U.S. Court of Appeals for the Fifth Circuit in Texas in the Texas Medical Association’s “TMA II” case under the No Surprises Act (NSA).
The government is appealing a Texas federal district court’s February decision that invalidated some of the Independent Dispute Resolution (IDR) portions of the final rule federal agencies issued to implement the NSA. The government asserts that it correctly instructed arbitrators in that rule to consider the Qualifying Payment Amount (QPA) before other factors in resolving payment disputes between physicians and insurers. In the government’s view, such instruction represented a “reasonable” exercise of its regulatory authority, which the district court failed to recognize. Similarly, the government claims that it followed the court’s order in TMA I to remove the QPA’s “privileged” status among all factors. The government also maintains that the district court in TMA II wrongly invalidated the QPA provisions of the final rule on a national basis, rather than only against the TMA and the other plaintiffs in that case.
The American College of Radiology® (ACR®) plans to continue advocating in court with the American Society of Anesthesiologists and the American College of Emergency Physicians for a fair IDR process under the NSA. The organizations will submit an amicus brief in August to support the TMA and other plaintiffs. Since the government has requested that the appellate court grant oral argument, this case may receive a hearing before a panel of judges and gain further visibility.
For more information, contact Tom Hoffman, ACR Vice President, Legal.
The government is appealing a Texas federal district court’s February decision that invalidated some of the Independent Dispute Resolution (IDR) portions of the final rule federal agencies issued to implement the NSA. The government asserts that it correctly instructed arbitrators in that rule to consider the Qualifying Payment Amount (QPA) before other factors in resolving payment disputes between physicians and insurers. In the government’s view, such instruction represented a “reasonable” exercise of its regulatory authority, which the district court failed to recognize. Similarly, the government claims that it followed the court’s order in TMA I to remove the QPA’s “privileged” status among all factors. The government also maintains that the district court in TMA II wrongly invalidated the QPA provisions of the final rule on a national basis, rather than only against the TMA and the other plaintiffs in that case.
The American College of Radiology® (ACR®) plans to continue advocating in court with the American Society of Anesthesiologists and the American College of Emergency Physicians for a fair IDR process under the NSA. The organizations will submit an amicus brief in August to support the TMA and other plaintiffs. Since the government has requested that the appellate court grant oral argument, this case may receive a hearing before a panel of judges and gain further visibility.
For more information, contact Tom Hoffman, ACR Vice President, Legal.