CHA News

Tri-Agencies Release Interim Final Rule on No Surprises Act Regulations

For CEOs, CFOs, government relations executives, finance & reimbursement staff, legal counsel

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On Sept. 30, the Departments of Health and Human Services (HHS), Labor, and Treasury released an interim final rule providing additional regulations implementing the No Surprises Act.  

The rule includes provisions related to the independent dispute resolution (IDR) process, good faith estimates for uninsured individuals, and the patient-provider dispute resolution process. In conjunction with the interim final rule, the tri-agencies launched a website related to the No Surprises Act, and the Centers for Medicare & Medicaid Services (CMS) provided technical guidance outlining the fee structure for the IDR process.  

Related to the IDR process, the interim final rule requires IDR entities to begin the arbitration process with the presumption that the qualified payment amount (QPA) is the appropriate payment amount for out-of-network services. For the IDR entity to deviate from the offer closest to the QPA, any information submitted by the parties to the arbitration must prove that the value of the service is materially different than the calculated QPA.  

A fact sheet related to the rule is available on the CMS website. CHA is currently reviewing the rule and will provide a summary soon. Comments on the rule, which CHA intends to submit, are due 60 days from the date the rule is published in the Federal Register.