Effective October 6, 2023, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) reopened the Federal Independent Dispute Resolution (IDR) portal for the initiation of certain new single and bundled disputes. In addition, the Departments will allow parties impacted by the suspension of the Federal IDR process under the No Surprises Act (NSA), more time to submit and respond to new disputes.
- Parties for whom the IDR initiation deadline required by regulation falls on a date beginning on August 3, 2023, through November 3, 2023, will have until the 20th business day after the Federal IDR portal reopens for new dispute processing, which was November 3, 2023, to initiate a new dispute.
- For new disputes initiated between October 6, 2023, and November 3, 2023, the deadline for certified IDR entity selection will be 10 business days after initiation, and the deadline to submit fees and offers will remain 10 business days after certified IDR entity selection.
- Disputing parties that were engaged in certified IDR entity selection when the Federal IDR portal temporarily closed will have 10 business days from October 6, 2023, to agree on a certified IDR entity.
- All other deadlines under the Federal IDR process remain unchanged.
On March 17, 2023, the federal government issued updated guidance regarding the independent dispute resolution process (IDR) under the No Surprises Act (the “Act”). The purpose of the updated guidance is to align the Act’s implementing regulations more closely to the plain language of the law.
The Act provides federal protections against balance billing, shielding patients from receiving unexpected, and often exorbitant, out-of-network medical bills. However, it’s implementing regulations have been under fire as unfairly favoring insurers over providers. Challengers argued that the August 2022 Final Rule required that undue weight be placed on the qualifying payment amounts (QPA) and median in-network rates, requiring arbiters to presume their correctness when determining payments.
Earlier this year, the United States District Court for the Eastern District of Texas arrived at the same conclusion; causing a halt on related payments until the challenged portion of the rule could be revised. On February 6, 2023, after hearing arguments in the matter of Texas Medical Association, et al. v. United States Department of Health and Human Services, the Court agreed with providers’ concerns that the August 2022 Final Rule implementing the Act improperly restricted an arbitrator’s discretion and created an unlawful bias in favor of the QPA when making price decisions. Therefore, the judge ordered that the challenged provisions be vacated and reconsidered.
Approximately one month later, on March 17, 2023, new guidance was issued instructing IDR entities to take a more balanced approach to making payment determinations. Specifically, the new guidance requires that IDR entities consider all information submitted by both parties without weighing one factor (such as QPA) more heavily than the others.
With the publication of the new guidance, CMS has announced the resumption of the IDR process. Additional information, including useful fact sheets and forms relating to IDR and the Act, can be found on the United States Centers for Medicare & Medicaid website.
Our Principal Attorney has hosted two free webinars relating to the No Surprises Act which can be found on the Campanella Law Office YouTube channel:
If you have questions about the No Surprises Act and how it affects you or your health care facility and payment procedures, contact us.