The Association of Air Medical Services challenged several aspects of the government’s regulations concerning QPA methodology. It contended that the government’s QPA methodology ran counter to the No Surprises Act by excluding most types of contracted rates between air ambulance providers and plans or issues, by treating hospitals and independent air ambulance services as providers in the “same or similar specialty,” and by using overly broad geographic regions that generate QPAs divorced from actual market pricing.
Judge Leon rejected these arguments, upholding the government’s actions, including its decision to exclude single case agreements from QPA calculations and its various definitions of “geographic region” for air ambulance services. Judge Leon also approved of the government’s basing of patient cost-sharing obligations for air ambulance services on the QPA, as opposed to an amount through open negotiation or the IDR process, remarking that the government had engaged in the “type of well-reasoned analysis that the APA requires!” For these reasons, Judge Leon granted the cross-motion for summary judgment of the departments of Health and Human Services, Labor, the Treasury, and the Office of Personnel Management and denied the motion for summary judgment of the Association of Air Medical Services.
Judge Leon’s opinion will likely provide key support for insurers and plans in IDR disputes with air ambulance providers because the opinion buttresses the QPA as a factor for determining the appropriate out-of-network rate for services. Another suit challenging similar QPA calculations for services other than air ambulance services remains pending in the U.S. Eastern District of Texas, Texas Medical Association, et al. v. United States Department of Health and Human Services, et al. This case is assigned to Judge Kernodle, who has issued three opinions invalidating NSA regulations on other grounds. The authors of this alert are closely monitoring these issues and pending litigation on the No Surprises Act and are available to answer any questions that may arise.
Newsflash 2023-174