On September 26, 2023, the Departments of Well being & Human Providers (HHS), Labor, and the Treasury (collectively, the Departments) collectively proposed guidelines (September Rule) updating the executive charge and Licensed Impartial Dispute Decision (IDR) entity charge ranges for the Federal IDR Course of underneath the No Surprises Act. The brand new proposed charges of $150 (from $50) will take impact on January 1, 2024, after a discover and remark interval. Feedback on the rule are due by October 26, 2023. This rule comes as a reduction to each payors and suppliers who’ve been ready to listen to when the Federal IDR Course of will restart after the portal has been partially paused as a result of latest litigation.

What’s the Federal IDR Course of?

The Federal IDR Course of was created underneath the No Surprises Act (NSA) to resolve fee disputes between payors and out of community suppliers referring to claims topic to the NSA. These NSA-covered claims embody:

• emergency providers furnished by a nonparticipating supplier or nonparticipating facility;
• an merchandise or service supplied by a nonparticipating supplier at a collaborating well being care facility; or
• air ambulance service supplied by a nonparticipating air ambulance supplier.

For extra data on the IDR Course of, please see our prior publish obtainable right here or take heed to our recorded webinar which might be accessed right here.

Background on the September Rule

The rule proposed this September was developed in response to the Texas Medical Affiliation case mentioned in our prior weblog issued in August (TMA IV). The foundation of that litigation was when the Departments issued an modification to the IDR course of growing the nonrefundable administrative charge for IDR from $50 to $350, a rise of 600%. On August 3, 2023, a United States District Decide within the Jap District of Texas issued an order vacating the IDR administrative charge enhance from $50 to $350 as a result of the modification was (i) issued with out discover and remark interval, and (ii) it was discovered to be arbitrary and capricious.

On account of the Texas District Court docket’s resolution, HHS briefly suspended the Federal IDR course of once more, together with the power to provoke new disputes, till the Departments may present further instruction, inflicting extra delays and complications for suppliers and payors. Nevertheless, on September 21 the Departments directed licensed IDR entities to renew processing all single and bundled disputes submitted on or earlier than August 3, 2023 in order that disputes can be prepared when the Federal IDR Course of reopens.

After TMA IV, the Departments proposed two guidelines associated to the Impartial Dispute Decision Course of.  The Workplace of Administration and Funds added these guidelines to its checklist of regulatory actions underneath overview and held 10 conferences with constituents and personal events to debate the proposals. In the end, the Departments revealed a proposed rule, “Federal Impartial Dispute Decision (IDR) Course of Administrative Payment and Licensed IDR Entity Payment Ranges”,  on September 26^th. To each payor and supplier’s reduction alike, the rule proposes to reopen the IDR course of in early 2024. Feedback on the proposed rule are due October 26, 2023. 

Need to Study Extra?

For extra data on latest developments and traits associated to the NSA, please view our webinar titled “A 12 months After the No Surprises Act: What We’ve Discovered and What to Watch Out For” from Thursday, September 28. The presentation might be accessed right here.

Payor/Supplier Convergence Weblog Collection

For added sources on the intersection of payor/supplier convergence and the problems that plague insurance coverage and well being firms, payors, and suppliers, click on right here to learn the opposite articles in our collection.

Foley is right here that can assist you deal with the short- and long-term impacts within the wake of regulatory adjustments. We now have the sources that can assist you navigate these and different vital authorized concerns associated to enterprise operations and industry-specific points. Please attain out to the authors, your Foley relationship associate, our Payor/Supplier Convergence Space of Focus, or to our Well being Care Observe Group with any questions.