CMS announces reopening the Independent Dispute Resolution (IDR) portal for new single and bundled (but not batched) claims. The Texas Medical Association (TMA) and additional plaintiffs have brought four Administrative Procedure Act (APA) challenges to the rules and guidance implementing the No Surprises Act (NSA) (termed TMA I, II, III and IV). Following the TMA III and TMA IV decisions, the IDR portal was suspended on Aug. 3 for all claims, and on Sept. 21, the portal was partially reopened only for single and bundled claims submitted to the portal on or before Aug. 3. For those bringing single or bundled claims to IDR where the initiation deadline would have been between Aug. 3 and Nov. 3, there has been a 20-business day extension to initiate a new dispute (normally four business days). Additionally, parties will have ten business days to select an IDR Entity (up from three days). For more information see the CMS FAQ for details. The portal remains closed for all batched claims (new and previously initiated) as CMS works to bring guidance and then portal functions/coding in line with the TMA IV decision that vacated the previously established batching requirements. CMS is focused on opening the portal to all claims as soon as possible and will consider similar timeline extensions.
CMS announces an initial six-month period of enforcement discretion related to the TMA III decision, which vacated many of the provisions related to calculation of the qualifying payment amount (QPA). CMS states that plans are expected to calculate qualifying payment amount (QPAs) using a good faith, reasonable interpretation of the applicable statutes and regulations that remain in effect after the TMA III decision, but the agency will be working to assist plans with recalculation rather than penalizing them over the next six months. Stakeholders should not expect additional guidance on the QPA calculation during this time. The Administration plans to appeal the TMA III decision. For more information, see the CMS FAQ.