HHS appealing Texas judge's surprise billing ruling

HHS April 22 filed a notice of appeal regarding a Texas federal judge's ruling that sided with providers in a lawsuit over the No Surprises Act. 

The Texas Medical Association sued the Biden Administration in October 2021 over the surprise billing resolution process. Providers took issue with a portion of the process that assumes the qualifying payment qualifying payment amount, which is the median in-network rate set by health insurers, is the appropriate out-of-network rate. 

The association claimed the reliance on the qualifying payment amount does not allow arbitrators to exercise discretion and weigh other relevant factors. Presiding Judge Jeremy Kernodle ruled in the association's favor in February, saying the rule "places its thumb on the scale" for the qualifying payment amount. 

The judge also ruled that HHS erroneously failed to issue notices and comment periods on the rule.  

The Justice Department is appealing the decision to the 5th Circuit Court of Appeals, according to its filing.  

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