No Surprises Act / IDR

FAH Position

FAH supported passage of the No Surprises Act but has vigorously opposed implementing regulations that weighted the qualifying payment amount over other factors Congress intended arbitrators to consider.

FAH’s core objection: CMS improperly weighted the QPA over other statutory factors, creating a thumb on the scale benefiting insurers over providers.

Legal Actions

Amicus Brief — TMA/AMA v. HHS (December 16, 2021)

FAH joined AHA, AAMC, America’s Essential Hospitals, Catholic Health Association, and Children’s Hospital Association supporting challenge to CMS interim final rule. Multiple courts subsequently struck down the QPA-centric approach.

Amicus Brief — Guardian Flight v. HCSC (October 2024)

FAH joined AHA, AMA, and TMA in 5th Circuit appeal supporting judicial enforceability of IDR awards. FAH argued the district court’s ruling “gives insurers significant leverage to demand confiscatory discounts.”

CMS Comment Letters

FAH submitted formal comments on IDR implementation (August 5, 2021) and on the IDR Operations Proposed Rule (December 2023).

Outcomes

The litigation strategy succeeded on the legal question. The system is now operating at 86 times its intended volume.

Sources

• CMS IDR data
• Congress.gov
• Healthcare Financial Management Association