Late on Friday, August 2, the Fifth Circuit Court of Appeals upheld a crucial ruling in the Texas Medical Associations (TMA) II lawsuit, marking another substantial victory for out-of-network providers and the TMA. This landmark decision affirms that the Departments (DOL, TREAS and HHS) do not have the authority to establish “substantive standards for the independent arbitrators to observe” and that Congress intended for the independent arbitrator to determine how to balance the QPA and all other factors in reaching a decision, not the Departments.
Specifically, the Court rejected the Departments efforts to require (1) arbitrators to first consider the QPA and then the other factors, (2) the arbitrators to not consider information that is not credible or related to the issue or that is already accounted for in the QPA and (3) the arbitrators to explain their reasons if they depart from the QPA.
The latest ruling clearly affirms that the IDR entities are empowered by Congress to evaluate each, and every offer based on their balancing of all information provided and that the Departments lack the authority to interject rules seeking to limit that authority.
We will continue to keep you apprised of any further developments related to the No Surprises Act as they become available.
