HHS to Revise Independent Dispute Resolution Guidance for No Surprises Act
On February 23, 2022, a federal judge in Texas ruled that the independent dispute resolution process implemented by the U.S. Department of Human and Health Services (HHS) within the No Surprises Act violated the Administrative Procedure Act. The Administrative Procedure Act oversees the process by which federal agencies develop and issue regulations and includes requirements for publishing notices of proposed and final rulemaking in the Federal Register. It also provides opportunities for the public to comment on notices of proposed rulemaking. Specifically, providers have issues with a portion of the dispute resolution process of the No Surprises Act that assumes the qualifying payment amount is the appropriate out-of-network rate.
In light of the federal ruling, the HHS along with the Departments of the Treasury and Labor stated it would revise its guidance for determining the payment amount for out-of-network services and train certified independent dispute resolution entities on the revised guidance.
The court’s order did not affect any of the departments’ other rulemaking under the No Surprises Act. Consumers continue to be protected from surprise bills for out-of-network emergency services, out-of-network air ambulance services, and certain out-of-network services received at in-network facilities. The patient-provider dispute resolution process for uninsured and self-pay consumers to dispute bills that exceed a provider’s or facility’s good faith estimate by $400 or more also remains available and unchanged by the court’s order.
