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No Surprises Act Payment Determinations Halted

The Department of Health and Human Services (HHS) on Feb. 10 instructed federal independent dispute resolution (IDR) entities not to issue new payment determinations in payment disputes related to out-of-network billing.

In a Feb. 6 ruling, the U.S. District Court for the Eastern District of Texas issued a judgment and order in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:22-cv-372 (TMA II) vacating certain portions of the No Surprises Act related to the consideration of the qualifying payment amount (QPA).

HHS is evaluating and updating the federal IDR process guidance related to the consideration of the QPA. IDR entities should continue to work through other parts of the IDR process until further guidance is issued.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Julie Kozminski is a senior policy analyst at America's Essential Hospitals.

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