February 08, 2023
Donaldo Hernandez, M.D., president of the California Medical Association (CMA), issued the following statement in response to the U.S. District Court ruling in Texas Medical Association (TMA) v. United States Department of Health and Human Services (HHS) – in which CMA filed a joint amicus curiae brief through the Physicians Advocacy Institute (PAI) – to preserve the balanced dispute resolution process established in the No Surprises Act.
“CMA physicians welcome this second federal court ruling against HHS’s flawed interpretation of the No Surprises Act. As the District Judge in the case noted, the arbitration process developed by HHS placed a thumb on the scale in favor of health plans. HHS's interpretation of the Act would have allowed insurers to set de facto benchmark payment rates for all independent dispute resolution cases rather than allowing independent arbiters to review a range of market payment factors – thereby allowing insurers to boost profits at the expense of physicians and patients.
"The Court’s decision is in keeping with the clear language of the No Surprises Act and Congress’ intent to provide a balanced process for health plans and physicians to resolve out-of-network payment disputes. By ruling in TMA’s favor, the Court has ensured that the No Surprises Act will not be upended by regulations that undermine the adequacy of physician networks and patient access to emergency care.”