LifeNet, Inc. v. HHS, 2022 WL 2959715 (E.D. Tex. 2022)
A federal trial court docket has once more vacated key parts of the interim remaining rules implementing the impartial dispute decision (IDR) provisions of the No Surprises Act—this time regarding air ambulance companies. As background, the No Surprises Act, enacted as a part of the Consolidated Appropriations Act, 2021 (CAA), expanded affected person protections to protect people from shock payments for sure out-of-network emergency and non-emergency companies, together with sure air ambulance companies. The businesses collectively issued two units of interim remaining rules addressing, amongst different issues, participant cost-sharing for companies topic to the CAA, in most conditions utilizing the qualifying cost quantity (QPA), which relies on the plan’s median in-network charge (see our Checkpoint article). The rules additionally tackle procedural features of plan funds of the out-of-network charge to nonparticipating suppliers and clarify the function of licensed IDR entities, the events’ submission of proposed cost quantities, and components licensed IDR entities could think about in deciding on a celebration’s cost quantity (see our Checkpoint article). The identical federal trial court docket beforehand invalidated a portion of the rules that prioritized the QPA over different components in figuring out the cost quantity for out-of-network emergency and non-emergency companies (see our Checkpoint article). Because of this, the businesses revised the IDR course of guides with respect to these companies however not air ambulance companies, which weren’t addressed in that ruling (see our Checkpoint article).
Within the present lawsuit, introduced by an air ambulance firm, the court docket thought of parts of the interim remaining rules specifying that, in figuring out the out-of-network charge for air ambulance companies throughout IDR, extra info thought of should “clearly exhibit” that the QPA is “materially totally different” from the suitable out-of-network charge. Characterizing the related provisions as “practically equivalent” to these at concern within the earlier choice, the court docket concluded that they equally have to be vacated, explaining that nothing within the statute compels IDR entities to weigh any issue or circumstance extra closely than the others. And the court docket once more held that the businesses’ failure to undertake the rules by means of notice-and-comment rulemaking (slightly than as an interim remaining rule) supplied a separate and impartial foundation for vacating the related provisions.
EBIA Remark: Presumably, the businesses will once more revise the IDR course of guides to mirror this choice. Plans and insurers ought to watch for added steering. For extra info, see EBIA’s Well being Care Reform guide at Sections XII.B.3 (“Shock Medical Billing: Emergency and Non-Emergency Companies”) and XII.B.4 (“Shock Air Ambulance Billing”). See additionally EBIA’s Group Well being Plan Mandates guide at Part XIII.B (“Affected person Protections”) and EBIA’s Self-Insured Well being Plans guide at Part XIII.C (“Federally Mandated Advantages”).
Contributing Editors: EBIA Employees.
