No Surprises Act Updates
No Surprises Act Updates
As reviewed in our summer issue, four rulings have been handed down by a federal judge in Texas – all favorable for emergency medicine. The plaintiffs in these four cases were the Texas Medical Association (TMA) and various other providers. The lawsuits and their respective outcomes are as follows:
- TMA lawsuits #1 and #2 – Decided in favor of TMA. Judge vacated arbitration criteria language in regulations. The Federal Government is appealing TMA 2.
- TMA #3 – Judge vacated QPA formula language.
- TMA #4 – Judge vacated $350 IDR fee language and batching language – violation of Administrative Procedures Act.
After the TMA #4 decision, the government shut down the IDR portal for new claim submission. At the time of this newsletter’s publication, the IDR portal remains closed.
Extensive regulatory and Congressional advocacy efforts by EDPMA and ACEP have been aimed at pressuring the Departments to adhere to the Congressional intent of the NSA. These efforts included interaction with Congressional staff, representatives, and senators related to Congressional hearings and feedback to the Departments that wrote the NSA regulations.
Insurers continue to actively obstruct fair implementation of the NSA. A sample of these insurer efforts include:
- Draconian decreases in payment amounts.
- Insurers not participating in open negotiations.
- Non-transparent QPA determinations.
- QPA not disclosed to providers.
- Extremely low QPA determinations – ghost contracts.
- Insurers not paying after IDR loss.
In the future, BSA Healthcare predicts that:
- Insurers will continue to throw full financial resources to lower contracted rates.
- Litigation will play a role.
- Departments will determine tolerance of insurer misbehavior.
- Department’s responsiveness to complaints is questionable.
Congressional action is uncertain.