Compliance Stuff

The US Departments of Treasury, Labor, and Health and Human Services have issued a sweeping final rule ( CMS -9897-F) implementing significant changes to the Federal Independent Dispute Resolution ( IDR ) process established under the No Surprises Act ( NSA ). This final rule has been long awaited by stakeholders, as changes were proposed by the Departments back in late 2023. It requires health insurers and plans (payers) to provide additional information on initial explanations of benefits (EOBs), reduces administrative fees to $15 per party per dispute, expands batching requirements, and implements substantial procedural reforms to the open negotiation and IDR initiation processes. These changes represent the most comprehensive revisions to the federal IDR process since its inception in 2022. The rule itself will become effective 60 days after it is published in the Federal Register, but some of its provisions will be implemented later. As background, US Congress passed the NSA to ...

In  Neurological Surgery Practice of Long Island, PLLC v. US Department of Health and Human Services et al. , the court dismissed a provider’s challenge to the federal agencies’ implementation of the independent dispute resolution entity (IDRE) selection procedures under the NSA. Providers should be aware of the court’s deference to agency discretion, the limitations on judicial remedies, and the ongoing regulatory developments that may impact future IDR proceedings. In the  case , a private neurosurgery practice in New York brought suit against the US Departments of Health and Human Services, Treasury, and Labor, alleging that the agencies’ procedures for selecting IDREs under the NSA were unlawful . The court reviewed the statutory framework of the NSA, which requires that providers and payers jointly select an IDRE within a three-business-day window. If the parties cannot agree, the agencies’ regulations provide that the initiating party (typically the provider) proposes a...