Texas court again stops No Surprise resolution process

by Roy Edroso on Aug 30, 2023
The independent dispute resolution (IDR) process with which HHS implements the No Surprises Act (NSA) has been blocked for a third time by a Texas court.

The Texas Medical Association (TMA) has sued HHS on this issue, claiming the way qualifying payment amounts (QPA) were calculated overstepped what the NSA allowed. QPAs are calculated to determine whether a disputed bill is appropriate, which is partly how IDRs are decided.

TMA won suits against the agency in February 2022 and February 2023; in both cases, HHS made changes to its QPA/IDR formula that the agency hoped would satisfy the litigants and the courts, and reopened its IDR process. 

But TMA went for three and won again in U.S. District Court for the Eastern District of Texas on Aug. 3.  CMS announced on Aug. 25 that HHS and the other U.S. Departments administering the process "have temporarily suspended all Federal IDR process operations in order to make changes necessary to comply with the court’s opinion and order. Disputing parties should continue to engage in open negotiation."

No word yet as to when another rule is expected.
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