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  • Washington Highlights

    Texas Judge Strikes Down Part of No Surprises Arbitration Rule

    Gayle Lee, Director, Physician Payment & Quality
    For Media Inquiries

    On Feb. 6, a federal judge for the U.S. District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association (TMA) in its most recent challenge of the surprise billing rules that were issued in August 2022 [refer to Washington Highlights, Aug. 25, 2022]. The judge ruled that the federal government’s revised independent resolution process included in its August 2022 surprise billing rule for determining payment for out-of-network services under the No Surprises Act unjustly favored insurers and is inconsistent with the language included by Congress in the No Surprises Act.  

    Previously, the TMA successfully challenged in court the arbitration process (included in a September 2021 surprise billing rule) that included a presumption that the qualifying payment amount (QPA) was the appropriate payment amount for out-of-network services [refer to Washington Highlights, Feb. 25, 2022]. After the court’s decision, the departments of Health and Human Services, Labor, and Treasury issued a revised surprise billing rule in August 2022. However, this rule still gave greater weight to the QPA, which is inconsistent with the language Congress had included in the No Surprises Act. In the decision on Feb. 6, the court struck down the specific provisions in the 2022 rule that still favored the QPA, ruling that the regulation "improperly limits" the discretion of the arbiter to consider other factors. As a result, arbiters must consider all the criterion referenced in the No Surprises Act statute without giving additional weight to the QPA. 

    In January, the TMA brought a separate legal dispute regarding implementation of the No Surprises Act, challenging the increase in the administrative fees charged to providers and payers to initiate the arbitration process.