Defendants’ Supplemental Brief Re: Vacate Surprise Medical Billing Rule

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

 ASSOCIATION OF AIR MEDICAL SERVICES,

                           Plaintiff,

v.                                                                  No. 1:21-cv-03031-RJL

U.S. DEPARTMENT OF HEALTH AND      Consolidated with
HUMAN SERVICES, et al.,                         No. 1:21-cv-03231-RJL

                          Defendants.

DEFENDANTS’ SUPPLEMENTAL BRIEF

Pursuant to this Court’s instructions at the hearing that it held in these consolidated cases on March 21, 2022, and this Court’s minute order entered on the same day, the Defendants respectfully submit this supplemental brief to address issues raised during that hearing.

I. THE DEPARTMENTS ADOPTED A REASONABLE METHODOLOGY TO CALCULATE THE QUALIFYING PAYMENT AMOUNT.

The No Surprises Act defines the “qualifying payment amount,” or QPA, in general, to be “the median of the contracted rates recognized by the plan or issuer, respectively … as the total maximum payment … under such plans or coverage, respectively, on January 31, 2019, for the same or a similar item or service that is provided by a provider in the same or similar specialty and provided in the geographic region in which the item or service is furnished,” subject to an inflation adjustment. 42 U.S.C. § 300gg-111(a)(3)(E)(i). Because the statute bases the calculation of a patient’s cost-sharing obligation for an out-of-network medical service (in the absence of a statutory exception) on the qualifying payment amount, the statutory definition “ensur[es] that any coinsurance or deductible is based on rates that would apply for the services if they were furnished by a participating provider, given that the QPA is generally based on median contracted rates, as opposed to rates charged by nonparticipating providers[.]” 86 Fed. Reg. 36,872, 36,884 (July 13, 2021).

View the detailed brief below.