On September 18, EDPMA filed an amicus brief in the Court of Appeals for the Fifth Circuit in support of the challenge by the Texas Medical Association to a provision of the Final Regulation of the Department of Health and Human Services under the No Surprises Act (“NSA”). The challenged provision implicitly calls upon Independent Dispute Resolution (“IDR”) entities to give paramount importance to the Qualifying Payment Amount (“QPA”) in the IDR process under the NSA. Our brief explains why the district court was correct in concluding that the provision wrongly tilts that process in favor of insurers — and is contrary both to the language of the NSA and to the congressional goal of assuring fair payment to out-of-network physicians.
Our brief highlights the problems caused by the challenged provision for emergency physicians and for patients. It provides factual support, based in part on EDPMA studies, that insurers’ manipulation of the QPA has adversely affected not only out-of-network payments, but in-network payments as well. It stresses that, in light of EMTALA and other factors, the challenged provision would be particularly harmful for the delivery of emergency medical care to patients.
The issues in the case are still being briefed, and we don’t know when the Court of Appeals is likely to issue a ruling. But we have taken a strong stand in support of our members and the patients we serve. See the EDPMA brief here.