CMS says more No Surprises Act processes can resume following pause

CMS on Sept. 21 directed certified independent dispute resolution entities to resume processing all single and bundled No Surprises Act disputes submitted on or before Aug. 3. 

CMS temporarily suspended all federal IDR processes on Aug. 25 in response to a Texas judge's latest ruling in a series of lawsuits challenging provisions of the No Surprises Act.  

In his Aug. 24 ruling, U.S. District Judge Jeremy Kernodle — who has overseen all four lawsuits filed by the Texas Medical Association — disallowed several provisions related to the qualifying payment amount. The TMA argued the provisions of the rule "skew negotiations in favor of health insurers so strongly that health insurers will force physicians out of insurance networks and physicians will face significant practice viability challenges, struggling to keep their doors open in the wake of the pandemic."

On Sept. 5, CMS directed certified IDR entities to proceed with eligibility determinations for single and bundled disputes submitted on or before Aug. 3.

Certain other IDR process functions remain temporarily paused as a result of that court ruling and another that Mr. Kernodle made earlier in August.

CMS said guidance will be provided in the near future regarding other issues associated with these two court decisions. 

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