EDPMA News Alert: Administration Responds to Court Ruling for Texas Medical Association re: No Surprises Act

As reported in yesterday’s EDPMA Advocacy Newsletter, on February 23rd, 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 Defendants’ 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.”
Late yesterday, the Administration provided its first official response to the lawsuit, issuing guidance from both the Department of Labor (DOL) and the Department of Health and Human Services (HHS). Regarding the changes that must be made related to the Federal Independent Dispute Resolution (IDR) process to comply with the court ruling, while more details must be issued, in particular, the Departments actions include:
  • Effective immediately, withdraw guidance documents that are based on, or that refer to, the portions of the Rule that the court invalidated. Once these documents have been updated to conform with the court’s order, we will promptly repost the updated documents.
  • Provide training on the revised guidance for certified IDR entities and Disputing Parties. This training will be offered through webinars and roundtable discussions, and will occur after the above-referenced documents are updated.
  • Open the IDR process for submissions through the IDR Portal. For disputes for which the open negotiation period has expired, the Departments will permit submission of a notice of initiation of the IDR process within 15 business days following the opening of the IDR Portal.

Importantly, the Departments note that all previous patient protections provided by the No Surprises Act remain in effect.

EDPMA is please and supportive of this result, both for clinicians and for patients, believing that this ruling restored the processes intended by Congress as the law was originally passed.
For the full announcements:
  • The HHS guidance (via the Centers for Medicare and Medicaid Services) can be found here.
  • The DOL guidance (via the Employee Benefits Security Administration) can be found here.
EDPMA will continue to provide updates as they become available.