CMS suspends all dispute resolution processes after latest No Surprises Act court loss

CMS said all federal independent dispute resolution processes are temporarily suspended in response to a Texas judge's latest ruling in a series of lawsuits challenging provisions of the No Surprises Act. 

The agency said the suspension is taking place while necessary changes are being made to comply with the court's decision, according to a Aug. 25 notice on CMS' website. Disputing parties should continue to engage in open negotiation.   

In his Aug. 24 ruling, U.S. District Judge Jeremy Kernodle —  who has overseen all four lawsuits filed by the Texas Medical Association — disallowed several provisions related to the qualifying payment amount. The TMA argued the provisions of the rule "skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic."

The ruling was the second time in August that Mr. Kernodle sided with the TMA (and fourth overall). He ruled Aug. 3 that federal agencies did not follow notice and comment requirements when hiking administrative fees 600 percent. He also invalidated certain rules narrowing batching claims for arbitration.  

Following that decision, CMS temporarily suspended all federal IDR processes. On Aug. 8, CMS announced certified IDR entities could resume processing batched disputes for eligible cases where administrative fees had been paid before Aug. 3.

The judge's latest decision has "led to the suspension of all of the previously resumed operations," CMS said. 

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