The Texas Medical Association filed suit against the Biden administration on Thursday hoping to quash a radiologist-opposed provision in legislation to address surprise medical bills.
Lone Star State docs believe the feds failed to follow congressional intent in a recently released interim final rule, spelling out how to settle quarrels over out-of-network payments. Lawmakers had recommended a robust dispute-resolution process that took several factors into account. But the medical association believes the final rule places too much emphasis on the “qualifying payment amount,” set solely by health insurers.
“We are disappointed the Biden administration ignored congressional intent and essentially set up the arbitration system to operate like a casino, with health insurers playing the role of the house,” association President Linda Villarreal, MD, said Friday. “Everyone knows the house always wins. With the current rule, patients, physicians and our country lose.”
TMA filed the lawsuit in the Tyler, Texas, federal district court against the departments of Health and Human Services, Labor and Treasury, along with their current leaders. Villarreal and colleagues said they support the No Surprises Act’s intent, with their complaint only challenging the independent dispute-resolution component. They believe the proposed approach is “short-sighted” and will drive down physician payment, narrow networks, and stifle patient access.
The suit urges the court to strike this portion of the rule, restoring the “fair, balanced dispute resolution process that Congress created.” It also accuses the administration of violating the Administrative Procedure Act, requiring a formal notice and comment period prior to finalizing such rulemaking. TMA—the largest state medical society in the U.S., representing 55,000 physicians and medical students—said its claims are backed by a recent letter from two powerful members of Congress, echoing providers’ concerns.
“Despite the careful balance Congress designed for the IDR process, the Sept. 30, 2021, interim final rule with comment strays from the No Surprises Act in favor of an approach that Congress did not enact in the final law, and does so in a very concerning matter,” Reps. Richard Neal, D-Mass., and Kevin Brady, R-Texas, chairman and ranking member, respectively, of the Committee on Ways and Means, wrote to the secretaries of the three agencies named in the suit on Oct. 4.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.