Late yesterday, Judge Jeremy Kernodle of the U.S. District Court for the Eastern District of Texas issued the court's decision in the Texas Medical Association case, a case that challenged a federal law that makes it harder for health care providers to bill patients amounts left unpaid by health plans.
In the ruling, Kernodle vacated new parts of the No Surprises Act, after finding that the administrative fee increase from $50 to $350, combined with the strict batching rules, violates the Administrative Procedures Act. As a result of this decision, independent dispute resolution (IDR) entities provided the following statements in response to parties attempting to initiate new IDR disputes:
"On August 3, 2023, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:23-cv-59-JDK (TMA IV), vacating certain portions of 45 C.F.R. § 149.510, 26 C.F.R. § 54.9816-8T, and 29 C.F.R. § 2590-716-8. As a result of the?TMA IV?decision, effective immediately, the Departments have temporarily suspended the Federal IDR process, including the ability to initiate new disputes until the Departments can provide additional instructions."
We anticipate the departments will issue some guidance in short order in the wake of this development. We are also continuing to analyze the decision to help provide additional guidance, but we wanted to let you know about this development, and also to provide a copy of the court's opinion.
This article is presented for informational purposes only and is not intended to constitute legal advice.