The federal government is planning to take another No Surprises Act court loss to the 5th Circuit Court of Appeals, according to an Oct. 20 court filing.
The Texas Medical Association filed a lawsuit in November arguing that portions of the No Surprises Act artificially deflate the qualifying payment amount. The group alleged the provisions of the rule "skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic."
In his Aug. 24 ruling, U.S. District Judge Jeremy Kernodle disallowed several provisions related to the QPA. According to the American Hospital Association, which filed an amicus brief supporting the TMA's argument, those disallowments include those that could allow insurers to include 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.
Mr. Kernodle did strike down TMA's challenge regarding disclosure requirements, according to the lawsuit.
The case was the third to be filed by the Texas Medical Association challenging portions of the No Surprises Act and the fourth to be decided by the judge. Mr. Kernodle largely sided with the Texas Medical Association in all four cases.
The federal government is appealing Mr. Kernodle's decision in the second case. In that case, Mr. Kernodle ruled the revised independent dispute resolution arbitration process "continues to place a thumb on the scale" in favor of insurers and "that the challenged portions of the final rule are unlawful and must be set aside."