As previously indicated, several lawsuits have been filed challenging the rules under the No Surprises Act regarding the presumption for Independent Dispute Resolution (arbitration) that the Qualified Payment Amount (QPA), the median in-network contract rate, is the proper reimbursement for out-of-network services covered under the No Surprises Act.
On December 9, 2021, a new lawsuit was filed in the Federal District Court in Washington D.C. by the American Medical Association (AMA) and American Hospital Association (AHA), along with representative providers, against the U.S. Department of Health and Human Resources and other departments, challenging this presumption.
The lawsuit seeks to stay pending judicial review of the QPA presumption or for summary judgment that the rules adopted for the QPA presumption violate Congressional intent in adopting the No Surprises Act. The plaintiffs have requested for a determination of the lawsuit on or before March 1, 2022, which is prior to the expected date that any claim would be filed for Independent Dispute Resolution.
Cohen Howard will continue to monitor this and other challenges to the No Surprises Act and update accordingly.