CMS finalizes changes to No Surprises Act administrative and IDR fees

The departments of Health and Human Services, Labor and the Treasury Dec. 18 released a final rule that increases the administrative fee for disputes initiated under the No Surprises Act independent dispute resolution process from $50 to $115 per party per dispute. The departments also finalize an increase to the fee range for certified IDR entities to $200-$840 for single determinations and $268-$1,173 for batched determinations. IDR entities will have discretion to increase the fee for batched disputes with more than 25 line items at a rate of $75-$250 per increment of 25 line items. The changes take effect for disputes initiated on or after 30 days after publication of the final rule in the Federal Register, which is anticipated to occur within the next week. These fees will remain in effect until changed by subsequent notice-and-comment rulemaking. 
 
In August, a federal judge in Texas 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.  
 
AHA Oct. 26 supported the proposal to use the Administrative Procedure Act process to establish the fees, but opposed, among other provisions, the fee increases and use of an inflationary adjustment for future increases.