On October 27, 2023, the US Departments of Health and Humans Services, Labor and the Treasury (the Departments), along with the Office of Personnel Management, issued a proposed rule titled Independent Dispute Resolution Operations (CMS-9897). The rule would permit the broader batching of claims under the No Surprises Act (NSA) and make other changes to the Federal Independent Dispute Resolution (IDR) process.
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The rule results from recent federal district court litigation challenging batching rules, among other aspects of the Departments’ implementation of the law. The rule is open for comment until January 2, 2024.
Much of the rule is in response to technical limitations that stakeholders have highlighted since the IDR process began, which have led to backlogs, challenges in correctly identifying the right venue for initiating disputes, and problems processing similar claims together. Below, we highlight the proposed changes related to batching of claims, new information to exchange prior to initiating IDR, and additional direction on IDR fees.
The proposed modifications to the batching and IDR processes would apply to disputes with open negotiation periods beginning on or after the later of August 15, 2024, or 90 days after the effective date of the final rules. However, the requirement for health plans to register on the IDR portal would take effect immediately upon publication of the final rule, and the changes to IDR fees would apply to disputes initiated on or after January 1, 2025. The Departments are also seeking comment on whether the new disclosure requirements would be effective six months or a year after additional sub-regulatory guidance is provided.
- A press release on the rule is available here.
- A fact sheet on the rule is available here.
For more information, please contact Kristen O’Brien or Jeffrey Davis.