Delays Expected on No Surprises Act Arbitration
In mid-April, the Department of Health and Human Services (HHS) launched the internet portal for resolving disputes over out-of-network payments under the No Surprises Act. Under the No Surprises Act, patients are protected from surprise medical bills if they receive out-of-network emergency care, out-of-network air ambulance services, or services from an out-of-network medical provider at a network facility. While the amount the patient pays for the service is relatively easily computable, the amount the health plan must pay the provider is less concrete.
The No Surprises Act requires the health care provider and health plan to first negotiate to determine an acceptable payment. If they cannot come to an agreement, the reimbursement amount will be decided by an arbitrator through an independent dispute resolution (“IDR”) process. This IDR process is initiated through the HHS internet portal.
The portal was initially scheduled for launch in March, but was pushed back by HHS after a court ruled in February that the criteria that the Departments of Health and Human Services, Labor, and the Treasury established for deciding IDR cases was unacceptable. Because of this delay, there is concern about a substantial backlog of cases waiting to be filed since compliance with the No Surprises Act began on January 1, 2022.
After selected for a case, arbitrators are supposed to make a decision on payment within 30 business days. The Department, however, has said it will grant extension requests submitted by the provider, health plan, or arbitrators or as appropriate. Therefore, stakeholders should not anticipate timely decisions until the backlog is processed.
The portal can be found at nsa-idr.cms.gov/paymentdisputes.