CMS issues additional IDRE instructions
Monday, February 13, 2023
AAMS Member Alert - February 13, 2023
On February 10th, the Centers for Medicare and Medicaid Services (CMS) issued the following instructions to the Independent Dispute Resolution Entities (IDRE’s):
As a result of the TMA II decision, the Departments are in the process of evaluating and updating Federal IDR process guidance, systems, and related documents to make them consistent with the TMA II decision. Effective immediately, certified IDR entities should not issue new payment determinations until receiving further guidance from the Departments. Certified IDR entities also should recall any payment determinations issued after February 6, 2023. Certified IDR entities should continue working through other parts of the IDR process as they wait for additional direction from the Departments.
The guidance above is in reference to the decision by the U.S. District Court for the Eastern District of Texas to vacate portions of the Final Rule implementing the No Surprises Act. These provisions instructed IDRE’s to consider the Qualified Payment Amount (QPA) first in their IDR determinations, and to assume that other factors listed in the law as being already accounted for by the QPA.
It is unknown when CMS will issue further guidance in light of the court’s ruling, and when the IDRE’s will be instructed to resume issuing payment determinations. AAMS is reaching out to elected officials to pressure CMS to lift this temporary hold on payments and work toward allowing the IDRE’s to make fair and equitable determinations based on the multitude of factors presented by the providers as the law intended. AAMS will continue to update the membership as more information becomes available.
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