Following a Feb. 6 court decision that vacated nationwide the federal government’s revised independent dispute resolution process for determining payment for out-of-network services under the No Surprises Act, the Centers for Medicare & Medicaid Services today instructed certified IDR entities to hold all payment determinations until the departments of Health and Human Services, Labor, and the Treasury issue further guidance. Certified IDR entities have also been instructed to recall any payment determinations issued after Feb. 6, 2023. 

“The Departments are currently reviewing the court’s decision and evaluating current IDR processes, guidance, templates, and systems for updates that will be necessary to comply with the court’s order,” CMS said. “The Departments will provide specific directions to certified IDR entities for resuming the issuance of payment determinations that are consistent with the court’s judgment and order. Certified IDR entities should continue working through other parts of the IDR process, including eligibility determinations, as they wait for additional direction from the Departments.”

A Texas judge on Feb. 6 held that the revised IDR process skews the arbitration results in commercial insurers’ favor in violation of the compromise Congress reached in the Act. As a result of this decision, the regulations are vacated nationwide.

Related News Articles

Headline
The House Energy and Commerce Subcommittee on Health Sept. 10 advanced the Title VIII Nursing Workforce Reauthorization Act (H.R. 3593), AHA-supported…
Headline
The House Appropriations Committee Sept. 9 advanced the fiscal year 2026 appropriations bill for the Departments of Labor, Health and Human Services, Education…
Headline
The AHA Sept. 4 expressed support for the Hospitals As Naloxone Distribution Sites Act (H.R. 5120), legislation that would require Medicare and Medicaid to…
Headline
The Senate Appropriations Committee July 31 advanced the fiscal year 2026 appropriations bill for the Departments of Labor, Health and Human Services,…
Chairperson's File
Public
The recently enacted One Big Beautiful Bill Act will bring big changes to health care. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue…
Chairperson's File
Public
This month Congress enacted the One Big Beautiful Bill Act — a sweeping package that contained many of President Trump’s legislative priorities on taxes,…