ACEP and EDPMA Applaud Legal Ruling to Invalidate Qualified Payment Amount Formula

The American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) applaud the decision released yesterday by the Eastern District Court of Texas (TMA) in the “TMA III” lawsuit regarding the Qualifying Payment Amounts (QPAs) under the No Surprises Act (NSA).

ACEP and EDPMA continue to support the overall intent of the law, which was to protect patients from unexpected financial cost-sharing responsibility for out-of-network care. We are supportive of the court’s recommendation to have the law implemented in a manner consistent with its original language and intent.

To read the full statement, click here.

EDPMA Chair of the Board, Andrea Brault, MD MMM FACEP, released the following statement regarding the summary judgement-in-part issued in favor of the Texas Medical Association (TMA), et al., in “TMA IV” and CMS’ subsequent freeze of the IDR and patient dispute process:

“On three consecutive occasions, the courts have vacated regulatory decisions related to the implementation of the No Surprises Act that deviate from statute to favor insurers at the expense of clinicians,” said Dr. Brault. “We will continue to support initiatives that bring regulations in line with the statute, with an emphasis on protecting clinicians and their patients.” To read the full statement, click here.

On Friday, August 4^th, the U.S. Department of Health and Human Services (HHS) suspended the No Surprises Act’s Federal IDR process after the August 3^rd court ruling against the federal Departments on the increase of the 2023 IDR Administrative Fee and a portion of the Departments’ IDR batching criteria.

We understand that this will be a severe disruption for emergency medicine providers seeking fair reimbursement from health plan underpayments for services furnished to patients in the emergency department. EDPMA will keep members apprised of additional developments and attempt to obtain clarity and additional information. In the meantime, see the HHS announcement on the suspension of Federal IDR below:

August 4, 2023 – EDPMA is very pleased that the United States District Court in Texas accepted the position of the Texas Medical Association, other plaintiffs, EDPMA, and others that filed amicus briefs that two actions by the federal agencies responsible for implementing the No Surprises Act were not taken in compliance with law and were therefore struck down. EDPMA applauds the decision of the District Court.  We believe that the challenged actions were contrary to fundamental fairness. Click here to read the full statement and court ruling.

July 21, 2023 – As providers on the front lines of emergency care in this country, the Emergency Department Practice Management Association (EDPMA) is deeply troubled by the
proposal to expand the use of the significantly flawed Qualified Payment Amount (QPA) benchmark to establish further government price controls in the commercial market for our fellow physicians and hospitals. The QPA was meant to establish a measure of patient cost sharing, not a benchmark for payment of providers. To read the issue brief and full statement, click here.