Federal Court Upholds TMA II Ruling: No Special Consideration for QPA

Last week, the Fifth Circuit Court of Appeals issued its ruling on “TMA II” and affirmed a previous ruling that found that the federal agencies must not give preferential weight to the suspect, insurer-calculated qualifying payment amount (QPA), an amount that is intended to reflect an insurer’s median-in-network contracted amount during the No Surprises Act's (NSA) Independent Dispute Resolution (IDR) process. The ruling affirms that the agencies failed to comply with the NSA statutory language in their rulemaking by giving preference to the QPA over the other factors during the IDR process. Moving forward, arbiters must consider all the criterion referenced in the No Surprises Act statute as written, without giving additional weight to the QPA.  ASA had filed two joint amicus briefs with the American College of Emergency Physicians and the American College of Radiology in support of the Texas Medical Association’s challenge to the agencies on this subject. ASA applauds the court's ruling and will continue to support efforts to ensure fair implementation of the NSA for both providers and patients.