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February 17, 2023

CMS Suspends Payment Determinations under the No Surprises Act’s IDR Process Following Texas Court Decision

As noted in last week’s edition of HLBytes, on February 6, the U.S. District Court for the Eastern District of Texas ruled in the Texas Medical Association’s favor, vacating portions of the August 26, 2022, Requirements Related to Surprise Billing Final Rule concerning the No Surprises Act’s federal independent dispute resolution (“IDR”) process. Specifically, the court found that the portions of the Final Rule related to the IDR process continued to conflict with the unambiguous terms of the No Surprises Act. The Rule required IDR entities to give greater weight to the qualifying payment amount than to the other factors the No Surprises Act directs an IDR entity to consider when determining the appropriate amount an out-of-network provider should be paid for an item or service that the Act prohibits the provider from balance billing a patient.  In light of this decision, on February 10, CMS notified all IDR entities to not issue new payment determinations and to recall payment determinations they issued on or later than February 6, 2023 pending further guidance. 

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