The Texas Medical Association notched another victory over HHS in its series of challenges against provisions of the No Surprises Act.
The Fifth Circuit Court of Appeals on Aug. 2 upheld a lower court's ruling in the TMA's challenge to the arbitration process between out-of-network providers and payers that was established under the surprise billing law.
In February 2023, U.S. District Judge Jeremy Kernodle ruled that the revised 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…"
In his ruling, Mr. Kernodle vacated all of the revised regulations challenged by the TMA, including HHS’ rule that arbiters must primarily consider the QPA.
The TMA said in an Aug. 5 news release that it is pleased with the appellate court's decision to uphold the Texas judge's ruling.
"We have long held that the federal departments lack authority to tell arbitrators how to weigh the factors during surprise billing arbitration," TMA president G. Ray Callas, MD, said in the release.
The lawsuit was the second of four lawsuits filed by the association challenging provisions of the No Surprises Act. Mr. Kernodle ruled in TMA's favor in all four cases.
HHS has also appealed another of Mr. Kernodle's rulings. In that case, the third lawsuit filed by TMA, the group argued that portions of the No Surprises Act artificially deflate the QPA. In his Aug. 24 ruling, Mr. Kernodle disallowed several provisions related to the QPA. The HHS' appeal is currently pending in the Fifth Circuit Court of Appeals.