chevron-down Created with Sketch Beta.
October 27, 2023

Biden Administration to Appeal No Surprises Act Ruling to 5th Circuit

On October 20, 2023, the U.S. government submitted notice to appeal Eastern District of Texas Judge Jeremy Kernodle’s August 24, 2023 decision, 2023 U.S. Dist. LEXIS 149393,setting aside regulations concerning the calculation of \  “qualifying payment amounts” (QPAs) for the No Surprises Act independent dispute resolution proceedings. Under the No Surprises Act, arbitrators must consider the relevant QPA(s) when adjudicating out-of-network reimbursement disputes between payors and emergency room and air ambulance providers in certain states. Judge Kernodle’s August 24th decision held in favor of providers challenging the regulations, finding that the regulatory methodology for calculating QPAs conflicted with the text of the No Surprises Act statute. Higher QPAs could lead not only to higher reimbursement rates  in No Surprises Act arbitrations, but also to increased out-of-pocket consumer costs. 

The material in all ABA publications is copyrighted and may be reprinted by permission only. Request reprint permission here.