AMA and AHA Support Texas Lawsuit Challenging IDR Provision of Surprise Billing Rule

On September 22, 2022, the Texas Medical Association (TMA) filed a lawsuit challenging the Independent Dispute Resolution (IDR) process under the No Surprises Act Final Rule released in August. That same day, The American Hospital Association and the American Medical Association announced they were filing an amicus brief supporting the TMA lawsuit.

In a joint statement, the AHA and AMA said, “Hospitals and doctors strongly believe that no patient should fear receiving a surprise medical bill and that patients should be kept out of the middle of any billing disputes between providers and commercial health insurance companies. The AHA and AMA fully support the lawsuit just filed in the United States District Court for the Eastern District of Texas, which challenges the government’s August 2022 final rule regarding the No Surprises Act’s independent dispute resolution process. We intend to make our voice heard in this case by filing an amicus brief that explains how the final rule departs from Congressional intent just as the September 2021 interim final rule did. The Texas court previously held that the interim final rule impermissibly rewrote clear statutory terms by placing a thumb on the scale in favor of commercial insurers. The final rule suffers from the same problems. As was the case with the previous suit, the AHA and AMA want to see the law’s core patient protections move forward and seek only to bring the regulations in line with the law. We look forward to supporting the Texas Medical Association’s efforts to restore the balanced, patient-friendly approach that Congress passed and the AHA and AMA supported.”

The final rule released in August removed the provisions instructing IDR entities to place emphasis on Qualifying Payment Amount (QPA), which is defined as the median contracted rate as of January 31, 2019, based on the same service in the same market. The new guidance specifies that IDR entities should select the offer that best represents the value of the item or service under dispute after considering the QPA and all permissible information submitted by the parties.

Read the XiFin Blog No Surprises Act: Examining the Independent Dispute Resolution Process | XiFin for more information on the final rule IDR process.