The Biden administration has filed an appeal to a ruling that vacated key parts of a rule that bans surprise medical bills.
The Department of Health and Human Services announced in a legal filing late Friday that it is appealing the ruling to the U.S. Court of Appeals for the Fifth Circuit. The decision to appeal the ruling originally issued back in February comes as HHS has other legal fights over the regulation.
Last fall the Texas Medical Association filed a lawsuit in the U.S. District Court for the Eastern District of Texas charging the rule which bans surprise billing conflicts with lawmakers’ intent and HHS bypassed notice and comment regulations.
The lawsuit is one of several filed by provider groups over a final rule HHS released last year outlining how to implement the No Surprises Act. The rule outlined the provisions for setting up an arbitration process for handling disputes between providers and payers for out-of-network charges.
The rule called for a third-party arbiter to settle such disputes but drew the ire of providers when the regulation called for the arbiter to rely on the qualifying payment amount — which is the average rate in a geographic area — when deciding.
Provider groups charged the rule was in stark violation of the intent of the No Surprises Act, which did not include a benchmark rate tied to regional out-of-network charges.
The judge in the Texas Medical Association case agreed with the association that HHS bypassed federal law for issuing regulations when not giving any notice or comment on the interim final rule. In addition, the judge ruled that HHS put too much weight on the qualifying payment amount.
Insurers, which had lobbied Congress to include a benchmark rate into earlier pieces of legislation, said the February ruling was misguided and would weaken protections for patients.
This is the latest lawsuit over the final arbitration rule. The American Medical Association and American Hospital Association filed their own lawsuit over the rule and an air ambulance group sued as well.