What’s happening: The Departments of Labor, Health and Human Services, and Treasury (the departments) issued new frequently asked questions (FAQs) related to enforcement discretion for certain disputes under the No Surprises Act.
What else to know: The FAQs are in response to the Aug. 24, 2023, decision in Texas Medical Association et al. v. United States Department of Health and Human Services et al. (TMA III) case.
The FAQs extend enforcement relief for any plan or issuer, or party to a payment dispute in the federal IDR process that uses a qualifying payment amount (QPA) calculated in accordance with the methodology in effect immediately before the decision in TMA III.
This enforcement discretion will be exercised for items and services furnished before Nov. 1.
The enforcement discretion will also extend to providers, facilities, or providers of air ambulance services who calculate cost-sharing amounts based on a QPA calculated in accordance with the methodology in effect immediately before TMA III.
The FAQs extend enforcement relief initially provided in FAQs Part 62 issued on Oct. 6, 2023, which acknowledged the court opinion and order in TMA III vacating certain regulatory and guidance provisions related to calculating the QPA. The October FAQs also acknowledged the significant resources and challenges associated with recalculating QPAs and offered six months of enforcement discretion.
Since initially releasing those first FAQs in October 2023, the departments received feedback that, despite efforts by plans and issuers to recalculate QPAs in a manner consistent with TMA III, those plans and issuers need additional time to come into compliance. These FAQs provide an additional six months of enforcement discretion.
The FAQs are available here.
