Effective October 6, 2023, the Departments of Labor, Treasury, and Health and Human Services (theTri-Agencies) advised that the independent dispute resolution (IDR) portal was reopened for certain No Surprises Act (NSA) disputes and provided two FAQs regarding qualifying payment amount (QPA) calculations and IDR administration following the ruling in TMA III (see the previous alert discussing this ruling).
Relevant to IDR, the portal was reopened for in-progress air ambulance disputes and new and in-progress single disputes. For disputes where the IDR initiation deadline falls between August 3, 2023, and November 3, 2023, the initiating party has until November 3, 2023, to submit the initiation. Disputes initiated on or before November 3, 2023, will have 10 business days for IDR entity selection, rather than the normal three business-day period. Parties will also have 10 business days to select the IDR entity if they were engaged in the selection process when the IDR portal was closed on August 3, 2023. However, the portal remains closed for new air ambulance disputes and for all new and in-progress batched disputes as the regulators continue to grapple with the impact of TMA III. These temporarily revised IDR procedures are discussed in the FAQs regarding the partial reopening of dispute initiation.
Regarding QPA calculation, the regulators issued new FAQs regarding NSA implementation to advise on the impact of the TMA III decision. This guidance states that payers are required to calculate QPA consistent with the decision, but the regulators will apply a good faith, reasonable interpretation of the applicable statutes and regulations that remain in effect. And while payers must continue to comply with QPA disclosure and certification requirements, the certification similarly is evaluated based on a good faith standard of compliance. Regulators will also exercise enforcement discretion as to any QPAs that are calculated in compliance with the pre-TMA III rules until May 1, 2024. This time frame will be reevaluated, but the FAQ states that enforcement discretion is unlikely to extend past November 1, 2024. Finally, when payers need additional information to determine air ambulance coverage and reimbursement, the regulators will encourage payers to attempt to obtain that information before the 30-calendar-day period to pay air ambulance claims under the NSA.
This article is presented for informational purposes only and is not intended to constitute legal advice.