Neutral policy analysis · not marketing · not legal advice
The QPA after TMA III: what the Fifth Circuit's ruling means
The Fifth Circuit's en banc ruling changed the ground under the QPA. Here is what it held and what it did not.
As of 2026-08-11 · 6 min read · Keyword: TMA III QPA ruling
What the court held
On August 11, 2026, the Fifth Circuit, sitting en banc, held in the TMA III matter that HHS unlawfully permitted insurers to depress the QPA calculation, by using so-called 'ghost rates' and by excluding certain bonus and incentive payments. The holding is generally read as favorable to providers on the specific methodology questions it addressed.
This is analysis, not legal advice
Nothing here is legal advice. Operators should confirm implications with counsel and watch for a post-TMA III QPA rule, which is widely expected.
Why it matters operationally
Because the QPA anchors payment determinations, a recalculated QPA could shift the baseline in many disputes. It also raises the stakes on defensibility: as methodology is re-litigated and re-issued, the ability to show a clean, dated record of what was submitted and why becomes more valuable.
What remains open
The decision does not itself recompute anyone's QPA, and the regulatory response is still to come. Estimates that rely on the pre-TMA III QPA benchmark should be read with that in mind.
Sources & evidence tiers
- VerifiedFifth Circuit en banc TMA III decision, Aug 11, 2026
- AdvocacyPost-decision legal commentary, Interpretive; confirm with counsel.
Figures are cited as of 2026-08-11 and reflect data available at that time. The IDR data environment moves quickly; verify current rules and figures with CMS and counsel.