District court invalidates additional No Surprises Act regulations

Aug 25, 2023 - 03:02 PM
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The U.S. District Court for the Eastern District of Texas for a third time ruled to set aside certain regulations implementing the No Surprises Act. In this case, the Texas Medical Association, joined by several air ambulance providers and supported by an amicus filed by the AHA, successfully argued that the methodology for how insurers calculate the qualifying payment amount tilts the arbitration process in insurers’ favor. The court specifically disallowed several regulatory provisions related to the QPA calculation, including those that could enable insurers to include in the calculation of QPAs contracted rates for services that providers have not provided, as well as allowing self-insured group health plans to use rates from all plans administered by a third-party administrator in calculating the QPA.  

The federal agencies administering these regulations have not indicated how they will proceed in light of this ruling. Currently, the No Surprises Act arbitration process is on hold as a result of separate litigation challenging other aspects of the No Surprises Act regulations.

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