WASHINGTON – On February 23, 2022, the U.S. District Court for the Eastern District of Texas granted the Motion for Summary Judgment filed by the Plaintiffs – the Texas Medical Association and Dr. Adam Corley – regarding their lawsuit challenging the federal government’s interim final rule implementing the independent dispute resolution process for reimbursement disputes between physicians and insurers.
The Memorandum Opinion and Order states “the Court concludes that the Rule conflicts with the Act and must be set aside under the Administrative Procedure Act (“APA”). … In sum, the Court holds that (1) Plaintiffs have standing to challenge Defendents’ September 2021 interim final rule implementing the No Surprises Act, (2) the Rule conflicts with the unambiguous terms of the Act, (3) the Departments improperly bypassed notice and comment in implementing the challenged portions of the Rule, and (4) vacatur and remand is the proper remedy.”
The Emergency Department Practice Management Association (EDPMA), an organization representing the practice of Emergency Medicine, filed an amicus brief, along with Texas ACEP and Virginia ACEP, in support of the Texas Medical Association’s and Dr. Adam Corley’s Motion for Summary Judgment. Throughout the legislative process, stakeholders agreed that patients should be removed from billing disputes and held only to their in-network cost-sharing amounts. EDPMA strongly supports the patient protections.
The Motion for Summary Judgment did not challenge these protections. The focus of the Motion and the court’s order is the process for resolving reimbursement disputes between insurance plans and physicians. Early legislative proposals that relied on a benchmark set at the plan’s typical in-network rate were rejected in favor of a compromise that considered evidence submitted by both the plans and the physicians. The statute clearly provides that the arbiter “shall consider” eight factors before deciding appropriate payment. The interim final rule would have inappropriately prohibited the arbiter from considering seven of those required factors except in special circumstances.
“EDPMA is thrilled that the Court has vacated and remanded the problematic Rule. Congress was clear when it passed the landmark No Surprises Act last year: protect patients from unavoidable and unexpected costs without jeopardizing patient access to care,” said Don Powell, D.O., Board Chair of EDPMA. “The Rule would have allowed insurers to manipulate payment standards with little or no transparency on the health plan’s calculation of ‘median in-network’ rates. This would have harmed not just commercially insured patients, but the rural, medically vulnerable and indigent populations who rely on our nation’s emergency departments as an important safety net.
“With the COVID-19 pandemic, and the latest wave of new variants, emergency department safety net resources have been stretched to the breaking point. We see the Rule would have led to dire effects on the overall viability of our emergency medical care system. We urged the Administration to amend the Rule to be consistent with the language of the statute and Congressional intent — and now the Court has forced them to do so.”