On Friday, Aug. 19, the Centers for Medicare and Medicaid Services (CMS) notified stakeholders that CMS, the U.S. Department of Health and Human Services, and the U.S. Department of the Treasury had released final rules on the No Surprises Act (NSA). CMS said the rulemaking took into account stakeholder input on last year’s interim final rules and two district court rulings on the new law. 

The notice, shared with the Indiana State Medical Association by the AMA, said the rulemaking was “narrow in scope, addressing specific issues related to disclosures by plans and issuers about the Qualifying Payment Amount (QPA) and guidance for certified independent dispute resolution (IDR) entities” on information to consider when making payment determinations.

CMS also released a new set of FAQs containing guidance on several NSA requirements, such as how the law’s protections apply to no-network and closed-network plans, requirements related to disclosures, and the calculation of the QPA.

The note from the three federal agencies to NSA stakeholders also included information about a status update on IDR, as well as additional guidance:

“Finally, the Departments also released a brief status update on the federal IDR process. In short, many more disputes have been submitted to the federal IDR process than were initially anticipated. Additionally, certified IDR entities are conducting significant work determining whether a dispute is eligible for the federal process.

“To help address this, on Tuesday we posted a new page on the CMS No Surprises Act website detailing some common mistakes and helpful tips for parties initiating IDR disputes. Our objective here is to help initiating parties get the certified IDR entities and non-initiating parties as much info on the front end as possible to help correctly determine eligibility and move disputes through the process. This also includes detailed technical guidance for the certified IDR entities on moving disputes through the process. While the guidance is technically for IDR entities, it’s publicly posted, and we think it could be helpful for disputing parties to keep in mind when they’re submitting information related to disputes. 

“We also rolled out some new functionality in the portal for initiating disputes. There’s now a dispute-level upload button which allows initiating parties to upload supporting documents to their disputes at initiation. We’re hopeful this will prevent delays in processing disputes by making sure that certified IDR entities have immediate access to documents like documents associated with the initial payment or notice of denial of payment (e.g., remittance advice or an explanation of benefits), notices of open negotiation initiation, extension requests, etc.”

Additional details are available at the following links:

News release: Rules provide key guidance for arbitrators; additional disclosure to providers, facilities

Final rule, fact sheet, other resources

New FAQs