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EB Flash: Final Rule Sets New No Surprises Act IDR Fees

Employee Benefits Alert

The U.S. Departments of Labor, Health and Human Services, and the Treasury released final regulations on December 18, 2023 that announced new No Surprises Act (NSA) Independent Dispute Resolution (IDR) administrative and IDR entity fees and that set up a notice and comment process and methodology for setting future IDR fees. The new fees take effect 30 days after the final rule is published in the Federal Register, which is scheduled for December 21, 2023.
Based on the methodology described in the final rule, the IDR administrative fee amount will be $115 per party for disputes. The certified IDR entity fee range will be $200-$840 for single determinations and $268-$1,173 for batched determinations. "Further, for batched determinations exceeding 25 dispute line items...certified IDR entities may set a fixed fee within the range of $75-$250 for each increment of 25 dispute line items included in the batched dispute, beginning with the 26th line item," CMS explains. These fees will remain in effect until otherwise changed under the rulemaking's notice and comment process.

A Centers for Medicare & Medicaid Services (CMS) fact sheet explains that the final rule sets the method for calculating the administrative fee and outlines the considerations used for the IDR entity fee ranges.

The rulemaking was prompted by court decisions in Texas Medical Association v. United States Department of Health and Human Services, No. 6:22-cv-450-JDK (Aug. 24, 2023 E.D. Tex.) (TMA III) and Texas Medical Association v. United States Department of Health and Human Services, No. 6:23-cv-59-JDK (Aug. 3, 2023 E.D. Tex.) (TMA IV), where plaintiffs challenged the IDR fee structure and methodology contained in federal regulations for determining the "qualified payment amount" used in rate determinations.

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