The Department of Health and Human Services (HHS) on Oct. 6 reopened the independent dispute resolution (IDR) portal for parties to initiate new single disputes and issued corresponding guidance. Parties may initiate single disputes involving bundled payment arrangements, but the ability to initiate new disputes involving air ambulance services remains unavailable.
Due to a court order, the Centers for Medicare & Medicaid Services temporarily suspended certain IDR functions on Aug. 3. IDR entities could resume processing existing single disputes on Sept. 21.
The court order also vacated certain regulation provisions on the calculation of the qualifying payment amount (QPA), which is used to determine payment for out-of-network services using contracted rates.
HHS on Oct. 6 released new QPA guidance. Plans and issuers are expected to calculate QPAs using a good faith, reasonable interpretation of applicable statutes, and regulations still in effect. HHS will use enforcement discretion until May 1, 2024, when the agency will reevaluate whether more enforcement relief is needed for plans and issuers to comply.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
Author