HHS to revise independent dispute resolution guidance for No Surprises Act

HHS will revise its guidance on the arbitration process outlined under the No Surprises Act following a federal court ruling. 

A federal judge ruled Feb. 23 that the independent dispute resolution process implemented by HHS violated the Administrative Procedure Act. The Texas Medical Association sued the Biden administration in October 2021 over the surprise-billing resolution process, claiming it did not meet Congress' vision for the bill. 

Providers have taken issue with a portion of the process that assumes the qualifying payment amount, the median in-network rate set by health insurers, is the appropriate out-of-network rate. 

HHS said it will revise its guidance for determining the payment amount for out-of-network services in light of the ruling. It also said it would train certified independent dispute resolution entities and disputing parties on the revised guidance. 

HHS will also permit parties to reopen a negotiation period for disputes if it expired. 

Read more here.

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