Immediately following a pair of court victories the Texas Medical Association won against federal agencies tasked with implementing the federal No Surprises Act, the Centers for Medicare & Medicaid Services (CMS) has again suspended the arbitration process for deciding out-of-network payment disputes between physicians and insurers under the 2020 federal law.
TMA continues to argue regulators failed to follow clear direction from Congress on how to implement the law’s independent dispute resolution (IDR) process, among other components.
On Aug. 3, the U.S. District Court for the Eastern District of Texas invalidated a 600% hike in the administrative fee to access the arbitration process, as well as certain rules that limited batching claims to those with the same service code. Then on Aug. 24, the same court struck down a large portion of the regulations surrounding a methodology insurers use to calculate the qualifying payment amount – one of several factors arbitrators consider when deciding an appropriate out-of-network payment.
“The departments have temporarily suspended all federal IDR process operations in order to make changes necessary to comply with the court’s opinion and order. Disputing parties should continue to engage in open negotiation,” states an Aug. 25 announcement posted on CMS’ No Suprises Act webpage.
The pause means disputing parties are unable to initiate new disputes, regulators said in an Aug. 30 email notice, adding they are “currently reviewing” the August decisions and “evaluating current IDR processes, templates, and system updates that will be necessary to comply” with the court orders.
CMS initiated similar IDR suspensions after TMA won its first two cases involving implementation of the No Suprises Act interim final rules governing arbitrations between insurers and physicians. TMA continues to monitor implementation of the federal law and compliance with these court rulings, especially given regulators’ lag in updating guidance in accordance with past rulings.
CMS said the federal agencies “will issue updates in the near future and will provide specific directions to certified IDR entities and disputing parties for resuming IDR-related activities in a manner consistent with the court’s judgment and order.”
For information and news regarding the No Suprises Act, visit TMA’s resource page.
Last Updated On
September 06, 2023
Originally Published On
September 06, 2023