CMS proposes changes to No Surprises Act IDR fees in response to court ruling

The departments of Health and Human Services, Labor and the Treasury yesterday released a proposed rule that would increase the administrative fee for disputes initiated under the No Surprises Act independent dispute resolution process from $50 to $150 per party per dispute, which would remain in effect until changed by subsequent notice-and-comment rulemaking. The departments also propose increasing the fee range for certified IDR entities by 20% for single determinations and 25% for batched determinations, which also would remain in effect until changed by subsequent notice-and-comment rulemaking. The changes would take effect for disputes initiated on or after Jan. 1 or the effective date of the final rule, whichever is later.

A federal judge in Texas last month ordered the agencies to vacate nationwide a federal fee increase and batching rule for the IDR process for certain out-of-network providers and group health plans because they violate the Administrative Procedures Act’s notice-and-comment requirement. In response to the ruling, the Centers for Medicare & Medicaid Services has temporarily suspended the IDR process, including the ability to initiate new disputes.