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.

In a strongly worded letter, Representatives Richard Neal and Kevin Brady, the Chairman and Ranking Member of the House Ways and Means Committee, urged three cabinet secretaries to take “swift action” to fix the No Surprises Act (NSA) final rule. Read the letter here.

The letter reminded the Secretaries that the No Surprises Act intentionally detailed a dispute resolution process that required arbitrators to equally consider several factors for their decision-making process, not just the Qualifying Payment Amount as some of our members are seeing in practice.

The final rule introduced a new “double counting” test that has no basis in the statutory text, directing IDR entities to “consider whether the additional information is already accounted for in the QPA… Even though the No Surprises Act explicitly requires an IDR entity to separately consider all of the statutory factors, the final rule precludes IDR entities from giving weight to factors like patient acuity and the complexity of furnishing the item or service at issue unless providers meet the heightened burden of disproving double-counting within the QPA.”

They further called out the Departments about their slow rollout of the Advanced Explanation of Benefits provision in the NSA.

EDPMA applauds the Ways and Means Committee leadership and stands with Representatives Neal and Brady in their demand to ensure the No Surprises Act aligns with the law and to “make the law’s transparency provisions a reality for patients.”

Urge Congress to Eliminate or Delay Scheduled Cuts to Medicare Physician Reimbursement

This week the House of Representatives is likely to consider legislation that will address some of the 9.75% cut to Medicare provider reimbursement that is scheduled to take effect in January 2022. The Senate will likely consider legislation soon thereafter. We urge you to reach out to your congressional delegation and ask them to support legislation that will eliminate or delay the scheduled Medicare cuts.

You can identify your member of the House and find their contact information by visiting www.house.gov and typing your zip code in the upper right corner. You can identify your two senators and find their contact information by visiting www.senate.gov and searching by senators by state. Since the vote is imminent, we recommend making these three phone calls and leaving your message with the person who answers the phone.

Get the background and talking points you need here.