This week, a Texas US Federal District Court granted a summary judgement in favor of the Texas Medical Association (TMA) setting aside and vacating the latest qualifying payment amount (QPA) Rule as violating the No Surprises Act (NSA). The Court acknowledged, “although the Departments have abandoned the ‘rebuttable presumption’ term, they have not relinquished their goal of privileging the QPA, titling arbitrations in favor of insurers, and thereby lowering payments to providers.”
The Final Rule issued in August 2022 took into consideration the Courts earlier Ruling invalidating the presumption that the QPA was the appropriate payment amount and that arbitrators were required to select the offer that was closest to the QPA unless credible evidence was presented to demonstrate that the QPA was materially different from the appropriate out-of-network rate. Notwithstanding, the Court found that the Final Rule continues to limit the discretion of the arbitrators in determining the payment amount.
According to the decision, the Court again stated “Nothing in the Act, moreover, instructs arbitrators to weigh any one factor or circumstance more heavily than the others… Rather, the Act instructs arbitrators to select one of the two offers submitted by the parties…” Please click here to learn more about the decision.