Texas District Court Overturns Portions of the IDR Process

On August 3, 2023, the US District Court for the Eastern District of Texas ruled on the implementation of the No Surprises Act in Texas Medical Association, et al. v. US Department of Health and Human Services, et al. (TMA IV).

In TMA IV, the plaintiffs challenged two things:

  1. The increased administrative fee to participate in the independent dispute resolution (IDR) process. Providers asserted that the fee made participating in IDR for small-value claims cost-prohibitive.
  2. The US Departments of the Treasury, Labor, and Health and Human Services (the Departments) rules regarding batching, which providers claimed made it difficult to batch related claims for resolution in a single arbitration proceeding.

The court found that the Departments violated the Administrative Procedure Act when they raised the IDR administrative fee from $50 to $350 for 2023 and established batching rules that did not allow providers to batch claims together in the IDR process. The court said that the changes were substantive and should have gone through notice and comment rulemaking. Ultimately, the court vacated both policies nationwide.

As a result, the IDR fee will return to $50 (for now). The batching rules are also vacated until the Departments go through rulemaking, resulting in a temporary suspension of the IDR portal. The Departments are working on a proposed rule that will likely include some batching policies.

The Departments can appeal this decision, as they did for TMA II.

Debra Curtis
Debbie is a highly respected health policy authority who helps clients advance their missions in Congress and beyond. With more than three decades of experience working both on the Hill and with the health insurance exchange marketplace, she helps clients execute payment strategy, see around the corner on policy and regulatory changes, and pursue effective advocacy. In addition, Debbie has deep experience working closely with payers, industry stakeholders and government officials at the federal, state and local levels. Read Debbie Curtis's full bio.

Kristen O'Brien
Kristen O’Brien is an accomplished healthcare executive with a deep understanding of regulatory advocacy and healthcare policy efforts. Kristen offers a strong background and a keen eye for solutions to barriers and challenges impacting healthcare clients. With more than 10 years of experience, her work focuses on implementing new laws through the rulemaking process, as well as working with relevant agency officials to develop and improve agency guidance. Read Kristen O’Brien's full bio.

Priya Rathakrishnan
Priya Rathakrishnan delivers comprehensive research and analysis of key federal health care legislative initiatives and policy developments. She assists clients with real-time monitoring and analysis of fast-breaking legislative, policy and regulatory developments in Washington, DC. She also coordinates coalition and client collaborations to achieve advocacy and policy goals. Read Priya Rathakrishnan's full bio.

Erica Stocker
Erica Stocker is a skilled policy and advocacy professional who has more than 20 years of experience in Washington, DC — including nearly 10 years working on Capitol Hill in health policy and office leadership roles, and more than a decade as a government relations professional and registered lobbyist. Read Erica Stocker's full bio.




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