On February 6, a federal court in Texas ruled in favor of the Texas Medical Association’s second legal challenge to the implementation of the No Surprises Act. The suit, commonly referred to as TMA II, challenged the federal governments' continued efforts to direct arbiters to give preference to the suspect, insurer-calculated qualifying payment amount (QPA), an amount that is intended to reflect an insurer’s median-in-network contracted amount. The Court noted that in the government’s August surprise billing final rule continued to direct arbiters to give preferential consideration to the QPA, “tilting arbitrations in favor of insurers, and thereby lowering payments to providers.” The Court stated that “the [No Surprises] Act nowhere states that the QPA is the primary or most important factor—or that it must be weighed more heavily than, or considered before, other factors.” In ruling in favor of the TMA, moving forward, arbiters will consider all the criterion referenced in the NSA statute as written, without giving additional weight to the QPA. However, the government may choose to appeal the ruling. The American Society of Anesthesiologists (ASA) filed a joint amicus brief with the American College of Radiology and the American College of Emergency Physicians with the Court in support of TMA II. The brief was referenced in the Courts ruling.
Date of last update: February 7, 2023