CMS halts, recalls billing arbitration decisions after Texas court vacates guidance. CMS said in a Friday notice that its departments “are in the process of evaluating and updating” implementation of the Federal Independent Dispute Resolution process to be consistent with a February 6 ruling from the U.S. District Court for the Eastern District of Texas. CMS instructed arbitrators on Friday to immediately stop issuing new payment determinations until further guidance is available. Further, arbitrators should recall any payment determinations that were issued after February 6.


District Court Vacates Provisions of No Surprises Act Final Rule.  On February 6, a United States District Court in Texas vacated provisions of the No Surprises Act final rule related to the independent dispute resolution (IDR) process for determining payment for out-of-network services. The district court granted summary judgment to the Texas Medical Association, which had brought suit against the US Departments of Health and Human Services (HHS), Labor and Treasury over the IDR process. The district court held that provisions of the final rule were contrary to law and therefore in violation of the Administrative Procedure Act (APA). The order vacated the provisions of the final rule that require IDR entities to look at the qualifying payment amount (QPA) first and consider other factors only if those other factors are not already accounted for in the QPA. The Departments have not yet filed a notice of appeal or amended their sub-regulatory guidance to align with the district court’s order.


Some older news about it:


HHS report includes information on operation of the IDR portal from April 15, 2022 through September 20, 2022. Report says that since the Federal IDR portal first opened, “parties have been submitting significantly more disputes than the Departments initially projected.”   Highlights of selected statistics in the report include:

  • From April 15 – September 30, 2022, disputing parties initiated 90,078 disputes through the Federal IDR portal.
  • Disputing parties initiated 18,163 disputes in the second calendar quarter, including disputes over items and services that would have been eligible for the Federal IDR process beginning January 1, 2022, when the surprise billing protections became effective.
  • Disputing parties initiated 71,915 disputes in the third calendar quarter, almost four times more than in the second calendar quarter.
  • Most disputes initiated in the second and third calendar quarters (86,807) were for emergency or non-emergency items or services, and the vast majority of the disputes were submitted by out of network health care providers and health care facilities.