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Texas District Court Rules in Favor of Providers in No Surprises Act Legal Challenge

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A Texas District Court on Wednesday ruled in favor of hospitals and providers in a suit brought by the Texas Medical Association challenging the administration’s Sept. 30, 2021, interim final rule (IFR).

The specific provision in question instructs arbiters to presume the “qualifying payment amount” (median in-network rate) is the appropriate payment rate for care delivered by out-of-network hospitals and providers in covered circumstances.

The judge in the case found the administration’s Sept. 30 IFR conflicted with the statutory language of the No Surprises Act (NSA) and ignored the framework it creates for determining the appropriate payment amount when care is delivered by out-of-network hospitals and providers in covered situations.

The ruling vacates portions of the IFR that direct arbiters to presume the qualifying payment amount is the appropriate out-of-network rate in isolation nationally; however, it does not affect other provisions of the NSA, such as the patient protections.

The administration can appeal this ruling. Additionally, there are other legal challenges (such as the one filed by the American Hospital Association and American Medical Association) that continue to progress in other district courts.