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- New Rule Proposed for No Surprises Act IDR Fees
On September 20, the Department of Health and Human Services (HHS), jointly with the departments of Labor and the Treasury proposed a new fee structure for the federal independent dispute resolution (IDR) process. This proposed rule would amend existing regulations for the IDR fees charged for single and batched determinations.
To engage in the federal IDR process, each party must pay to the certified IDR entity (1) the administrative fee due to the departments and (2) the entire certified IDR entity fee. The proposal makes changes to the administrative fee amount, the methodology used to calculate the administrative fee amount, considerations used to develop the certified IDR entity fee ranges, and the certified IDR entity fee ranges for disputes initiated on or after January 1, 2024. Specifically, the departments are proposing to increase the administrative fee to $150 per party, per dispute. This amount is not refunded to either party regardless of the outcome of the IDR determination. The IDR entity fee is also going up, but this amount is returned to the prevailing party.
The CAP has urged HHS not to increase the administrative fee from the original $50 amount, stating that an increase represents a significant barrier for small and rural providers/practices, and for most of pathology, in accessing the IDR process at all. The CAP will comment on the proposed rule and will continue to work with the CMS to address problems members and others are experiencing.
Previously, the Texas Medical Association recently sued Centers for Medicare & Medicaid Services (CMS) over several aspects of the No Surprises Act. In August, the CMS suspended the IDR process after a federal court judge ruled in favor of the Texas Medical Association. The judge found that the CMS did not follow processes to increase fees and ruled that the Departments cannot impose a substantial fee change without notice and comment rulemaking. The September 20 proposed rule is a direct response to that ruling.