The Texas Medical Association (TMA) has been at the forefront of challenging aspects of the No Surprises Act (NSA), now with its third lawsuit, TMA III, building on previous cases aimed at ensuring fair payments for healthcare providers. TMA’s previous lawsuits argued that the government’s focus on the Qualified Payment Amount (QPA) as the standard for setting out-of-network reimbursement unfairly lowered payments to levels that threaten provider stability. TMA I and TMA II laid the groundwork, bringing attention to the limitations of relying solely on the QPA as a benchmark. 

In TMA III, the case continues to address the impact of these low rates, arguing that the QPA does not accurately reflect the costs of care or market realities. TMA hopes to create a more balanced reimbursement system that supports both providers and patients. The latest hearings have focused on whether the QPA should be the primary factor in setting rates or if other elements should also be considered to achieve a fair outcome. 

To understand the implications of these cases for healthcare providers and patients alike, listen to the newest episode of Zotec Answers, where Ed Gaines, Vice President of Regulatory Affairs and Industry Liaison at Zotec Partners, discusses TMA’s efforts and the potential changes that could reshape reimbursement practices. Stay tuned for updates as TMA’s cases move forward and the landscape of the NSA continues to evolve.