Texas Medical Association et al. v. U.S. Department of Health and Human Services et al. (TMA IV)

Why this Matters:

The plaintiffs argue that regulations to impose guardrails and set administrative fees with respect to 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 and devise a sustainable funding model to support 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 and administrative fees for the No Surprises Act’s arbitration process could lead to abuses of the process and higher health care costs and premiums.