Employers will recall that the Consolidated Appropriations Act of 2021 contained a prohibition on surprise medical bills in many situations, called the No Surprises Act*. Since the law’s enforcement in 2022, one key element of the rule has faced legal challenges in several states. Notably in December 2022, the Texas Medical Association (TMA) brought suit challenging the laws’ methodology for determining the ‘qualified payment amount’ (QPA)** as the basis for settlement of fees under the rule***. Other parties have also brought suit on the same grounds.**** On February 7, the Texas Court vacated the part of law governing independent dispute resolution (IDR) and QPA, leaving a sort of hole in the current rule when it comes to settlement of disputed fees.

The Department of Health and Human Services is back to the drawing board in terms of the IDR process. Any payment determinations that have been made following the Texas Court’s February ruling are on hold and being recalled.

As we wait to see how the legal challenges unfold, employers can rest easy as the law itself remains intact. Patients remain protected from balance bills in emergency situations, and when they receive services from an out of network provider when visiting an in-network facility or service provider.

*The text of the Act can be found here

** The QPA is the median contracted amount for the servicer at issue, generally set by insurance carriers

*** The litigation stems from the August 2022 final IDR rule

**** Air ambulance companies also sued under the No Surprise Acts