Potential Impact:
Why this Matters:
The plaintiffs argue that regulations to impose guardrails on the No Surprises Act’s arbitration process—a process used to resolve payment disputes for surprise out-of-network bills between payers and out-of-network health care providers—are invalid under the Administrative Procedure Act. If federal agencies cannot set reasonable guidelines for arbitrators, certain providers could be more likely to try to abuse this process to obtain higher payments, making the arbitration process more likely to become inflationary and leading to higher health care costs and premiums.
Potential Impact:
The inability to impose reasonable guardrails for the No Surprises Act’s arbitration process could lead to abuses of the process and higher health care costs and premiums.
Texas Medical Association et al. v. Department of Health and Human Services et al. (TMA I)
Goal
Issues
Case History
Litigation Content
Potential Impact:
Why this Matters:
The plaintiffs argue that regulations to impose guardrails on the No Surprises Act’s arbitration process—a process used to resolve payment disputes for surprise out-of-network bills between payers and out-of-network health care providers—are invalid under the Administrative Procedure Act. If federal agencies cannot set reasonable guidelines for arbitrators, certain providers could be more likely to try to abuse this process to obtain higher payments, making the arbitration process more likely to become inflationary and leading to higher health care costs and premiums.
Potential Impact:
The inability to impose reasonable guardrails for the No Surprises Act’s arbitration process could lead to abuses of the process and higher health care costs and premiums.
News And Analysis (2)
Health Affairs
The No Surprises Act: A Litigation Status CheckHEALTH AFFAIRS
Provider Groups Each Bring Third Lawsuit Challenging No Surprises Act24 Major Filings
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APPELLATE ORDER (Oct 24, 2022)
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NOTICE OF APPEAL (Apr 22, 2022)
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FINAL JUDGMENT (Feb 23, 2022)
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OPINION and ORDER (Feb 23, 2022)
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REPLY in Support of Motion for SJ (Feb 2, 2022)
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REPLY in Opposition to Motion for SJ (Jan 24, 2022)
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SUPPLEMENTAL Admin Record (Jan 24, 2022)
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AMICUS BRIEF American Benefits Council (Jan 18, 2022)
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AMICUS BRIEF Americas Health Insurance Plans (Jan 18, 2022)
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AMICUS BRIEF Blue Cross Blue Shield (Jan 18, 2022)
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AMICUS BRIEF Congressional Committee Leaders (Jan 18, 2022)
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AMICUS BRIEF Health Policy Experts (Jan 18, 2022)
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AMICUS BRIEF Leukemia and Lymphoma Society (Jan 18, 2022)
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REPLY in Opposition to Amicus Brief (Jan 18, 2022)
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CROSS MOTION for SJ (Jan 10, 2022)
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AMICUS BRIEF [MEMBERS OF CONGRESS] (Jan 3, 2022)
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ORDER (Dec 24, 2021)
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DEFENDANTS' RESPONSE TO MOTION FOR LEAVE TO FILE AMICUS BRIEF (Dec 21, 2021)
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AMICUS BRIEF Medical Association of Georgia (Dec 17, 2021)
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AMICUS BRIEF [ACTION FOR HEALTH INC.] (Dec 17, 2021)
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AMICUS BRIEF [EMERGENCY DEPARTMENT PRACTICE MANAGEMENT ASSOCIATION ET AL.] (Dec 17, 2021)
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AMICUS BRIEF [PHYSICIANS ADVOCACY INSTITUTE ET AL.] (Dec 17, 2021)
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PLAINTIFFS' MOTION FOR SUMMARY JUDGEMENT (Dec 10, 2021)
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COMPLAINT (Oct 28, 2021)
View MoreRelated Litigation
Litigation Information
Current Status
Decision issued
Legal Issues
Administrative Procedure Act - Contrary to Law, Administrative Procedure Act - Notice and Comment Violation, Administrative Procedure Act - Lack of Statutory Authority
Topic(s)
Arbitration Regulations
Litigation Metadata
Physicians Advocacy Institute et al.; Medical Association of Georgia et al.; Emergency Department Practice Management Association et al.; Action for Health, Inc.; Members of Congress
Leukemia & Lymphoma Society et al.; Health Policy Experts; Congressional Committee Leaders; Blue Cross Blue Shield Association; America’s Health Insurance Plans; American Benefits Council et al.