Texas District Judge Jeremy Kernodle largely sided in favor of the Texas Medical Association in the four lawsuits the organization filed against HHS challenging provisions of the No Surprises Act.
CMS temporarily suspended federal independent dispute resolution processes in response to the latest court rulings. In a Sept. 5 update, CMS directed certified IDR entities to proceed with eligibility determinations for single and bundled disputes submitted on or before Aug. 3. All other aspects of the IDR process operations remain suspended. Disputing parties may continue to engage in open negotiation.
To date, the federal government has appealed one of the four cases to the 5th Circuit. In that case, Mr. Kernodle ruled 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.”
Loren Adler, associate director of the USC-Brookings Schaeffer Initiative on Health Policy, told Bloomberg Law that the case is likely to reach the U.S. Supreme Court.
Mr. Adler said “we’re a while away from a resolution” and noted the big question is what happens in the interim as the arbitration process is paused.
“You can’t go to arbitration if there’s no rules at all,” he told the news outlet.
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