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Licensing rules governing medically related matters, like quality of medical services and equipment, are not preempted by the ADA. Med-Trans Corp. v. Benton, 581 F. Supp. 2d 721, 740 (E.D.N.C. 2008) (invalidating only the CON requirements needed for air ambulance to enter the North Carolina market). See also Hiawatha Aviation of Rochester, Inc. v. Minn. Dep't of Health, 389 N.W.2d 507, 509 (Minn. 1986) (invalidating Minn. Stat. § 144.802 (1982)).Google Scholar

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The court found that PHI would not likely recover less under the fair and reasonable reimbursement standard because even the trial court's determination that the fair and reasonable reimbursement rate was 125% of Medicare rates was based on the price that PHI agreed to charge the one customer with which it had a contract. Texas Mutual Ins. Co., 2020 WL 347700263, at *8, 12.Google Scholar

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Texas's law applied the balance billing prohibition only to workers’ compensation claims. Tex. Lab. Code Ann. § 413.042. The Sullivan court did not address the balance billing prohibition specifically because it had found the air ambulance provider's first argument, that the worker compensation law was a form of rate restriction was preempted by ADA, persuasive. Sullivan, 331 F. Supp. 3d at 656, FN 4. Therefore, the alternative argument regarding preemption of the balance billing section was not examined. Id.Google Scholar

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The typical surprise medical billing benchmark is median innetwork rates, but for air ambulances, that standard is less meaningful because the vast majority of services are out-ofnetwork and pervasive market failures result in highly inflated in-network rates. So a multiple of Medicare rates is a more reliable benchmark for air ambulances. Fuse Brown et al., supra note 3.Google Scholar

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