Lawsuits and logjams: A No Surprises Act timeline

The No Surprises Act was signed into law in late 2020 in an effort to end surprise medical bills for emergency and scheduled care. But the law has since faced a number of legal challenges as well as a substantial backlog of claims. 

Here is a timeline of the No Surprises Act and the challenges it faced since it was signed into law:

Dec. 31, 2020: The No Surprises Act is signed into law. The rules are set to take effect in January 2022. 

April 23, 2021: Politico reports that health systems, insurers, trade associations, ambulance companies and physician staffing firms have increased lobbying efforts to determine how the U.S. will enforce its ban on surprise medical billing.

July 2, 2021: CMS unveils the No Surprises Act's interim final rule. The rule details how payments from health plans to providers will be determined. It appears to keep payment rates lower than those lobbied for by hospitals and other healthcare providers.

Oct. 28, 2021: The Texas Medical Association sues over what it says is an unfair process to resolve billing disputes between health insurers and providers. It is one of several organizations to file lawsuits challenging the rule. 

Jan. 1, 2022: The No Surprises Act takes effect

Feb. 23, 2022: A federal judge in Texas rules that the No Surprises Act arbitration process implemented by HHS violated the Administrative Procedure Act, delivering a win to the Texas Medical Association. U.S. District Judge Jeremy Kernodle says the rule "places its thumb on the scale" for the qualifying payment amount.

March 2, 2022: HHS says it will revise its guidance on the arbitration process outlined under the No Surprises Act following the federal court ruling. 

April 22, 2022: HHS files a notice of appeal regarding the Texas federal judge's ruling in the Texas Medical Association case.

May 3, 2022: HHS requests a hold on its appeal, which is granted. 

Aug. 19. 2022: HHS and the Labor Department issue final rules for the No Surprises Act.

Sept. 20, 2022: The American Hospital Association and American Medical Association announce they are dismissing a lawsuit they filed challenging the No Surprises Act, but say they remain concerned that the final rule "continues to favor insurers and does not line up with what Congress intended when it passed the law."

Sept. 22, 2022: The Texas Medical Association files a second lawsuit challenging the No Surprises Act, arguing the final rule will "unfairly advantage health insurers by requiring arbitrators to give outsized weight or consideration to the [qualifying payment amount]." 

Oct. 19, 2022: The AHA and the AMA, along with 30 additional national and state medical groups, file amicus briefs in support of the Texas Medical Association's second lawsuit.  

Nov. 28, 2022: The Texas Medical Association's lawsuit challenging the validity of the No Surprises Act's independent dispute resolution could increase an already lengthy backlog, Bloomberg Law reports. HHS launched the independent dispute resolution portal in April and received more than 90,000 claims in the first five and a half months, substantially more than the department initially estimated would be submitted for a full year.  

Nov. 30, 2022: The Texas Medical Association files its third lawsuit against the No Surprises Act, arguing that portions of the rule "artificially deflate the qualifying payment amount."

Jan. 31, 2023: The Texas Medical Association files a fourth lawsuit, this time challenging a 600 percent hike in administrative fees when seeking dispute resolutions. 

Feb. 6, 2023: Mr. Kernodle rules in favor of the Texas Medical Association in its second lawsuit. He rules that the revised arbitration process "continues to place a thumb on the scale" in favor of insurers and "that the challenged portions of the final rule are unlawful and must be set aside."

Feb. 10, 2023: CMS instructs certified independent dispute resolution entities to hold all payment determinations under the No Surprises Act until HHS and the Treasury Department issue further guidance. 

Feb. 27, 2023: CMS says certified independent dispute resolution entities can resume issuing No Surprises Act payment determinations involving out-of-network services and items furnished before Oct. 25, 2022.

March 16, 2023: Representatives for both providers and payers say dispute arbitrators are often not following the No Surprises Act, Bloomberg Law reports.  

April 18, 2023: A report from the Urban Institute and the Georgetown University’s Center on Health Insurance Reforms finds that the No Surprises Act is largely protecting patients from the most pervasive forms of surprise billing, but the gaps that do remain have left some with unexpected financial liabilities.

Aug. 3, 2023: Mr. Kernodle rules in favor of the Texas Medical Association in its fourth lawsuit. He found that federal agencies did not follow notice and comment requirements when hiking administrative fees. He also invalidated certain rules narrowing batching claims for arbitration. HHS said it was temporarily suspending the IDR process — including the ability to initiate new disputes — until the federal agencies can provide additional instructions. 

Aug. 11, 20223: CMS lowers the IDR fee to $50 following the government's latest court loss.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars