Advocacy Alert

Urge Your Lawmakers to Support Essential Health System Designation

HHS Delays Surprise Billing QPA Enforcement

Julie Kozminski
May 7, 2024

The Department of Health and Human Services (HHS) on May 1 released guidance delaying enforcement of the new qualifying payment amount (QPA) guidance until Nov. 1.

Previously, a court order vacated certain No Surprises Act provisions on the QPA calculation, which is used to determine payment for out-of-network services using contracted rates. In October 2023, HHS released new guidance on how to calculate QPAs in a manner consistent with statutes and regulations that remain in effect. HHS was scheduled to begin enforcing the new QPA calculation May 1.

HHS now will exercise enforcement discretion for any plan or issuer through Nov. 1, as several of the changes to the QPA calculation methodology necessitate a manual process to locate data.

Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.

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