No Surprises Act

Executive Order GA-40

On July 26, 2022, Judge Jeremy Kernodle of the Eastern District of Texas affirmed that certain parts of the Interim Final Rule Part II implementing the No Surprises Act (the Act) were invalid. This ruling is nearly identical to Judge Kernodle’s February decision in Texas Medical Association & Corley v. US Dept. of Health and Human Services. This decision vacated a portion of the Interim Final Rule that required arbitrators to give more weight to the out-of-network rate, including what is called the Qualified Payment Amount (QPA), over other permissible factors. The rule’s requirement ultimately contradicted the Act’s direction that arbitrators consider various factors, and not weight any one more heavily than another.

No surprises legal alert

On February 23, 2022, Judge Jeremy Kernodle of the Eastern District of Texas ruled that certain parts of the Interim Final Rule Part II (the Rule) implementing the No Surprises Act are invalid. Specifically, the provisions of the Rule governing the methodology for how arbitrators determine the amount of payments insurers and self-funded health plans…

On July 1, 2021, the Office of Personnel Management (“OPM”), the Internal Revenue Service (“IRS”), the Department of Treasury (“Treasury”), the Employee Benefits Security Administration (“EBSA”), the Department of Labor (“DOL”), the Centers for Medicare & Medicaid Services (“CMS”), and the Department of Health and Human Services (“CMS”) (collectively the “Departments”) jointly issued the Interim Rule – Requirements Related to Surprise Billing; Part 1 (hereinafter, the “Interim Rule” or the “Rule”). This Interim Rule is the first implementing regulation of the federal No Surprises Act (alternatively the “Act”) which was enacted on December 27, 2020 as part of the Consolidated Appropriations Act. Both this Interim Rule, and the Act, are effective applicable for plan years beginning on or after January 1, 2022.