LifeNet, Inc. et al v. U.S. Department of Health and Human Services et al. (LifeNet III)

Why this Matters
The plaintiffs argue that regulations outlining the methodology used to calculate the No Surprises Act’s qualifying payment amount for air ambulance services (the basis for determining individual cost sharing for items and services covered by the balance-billing protections), and describe when and how certain disputes should be handled through the arbitration process, are invalid under the Administrative Procedure Act. The design of the qualifying payment amount is critical to the No Surprises Act’s mission to promote lower health care premiums and costs. 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
Setting aside the methodology to calculate the qualifying payment amount for air ambulance services could expose patients to higher cost sharing and make the arbitration process more likely to raise health care costs and premiums.