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Court Rejects No Surprises Act’s QPA Methodology

A federal appeals court has rejected how health care payers calculate their qualifying payment amount, or QPA, when addressing disputed payments under the No Surprises Act’s Independent Dispute Resolution process. The QPA is the central benchmark rate payers present to help settle out-of-network medical billing disagreements that for years led to surprise medical bills for many hospital patients. The court concluded that payers should not be permitted to include so-called ghost rates when calculating their QPA; a ghost rate is a rate for services that a given provider does not actually provide, leaving the provider no incentive to attempt to [...]

joe2026-08-13T15:13:04-04:00August 14, 2026|Uncategorized|

CMS Clarifies Upcoming IDR Changes

Earlier this year, the departments of Health and Human Services, Labor, and the Treasury and the Office of Personnel Management published federal Independent Dispute Resolution operations final rules to improve the functioning of the No Surprises Act’s IDR process, which is part of a broader effort to eliminate surprise medical bills. The new rules seek to streamline communication between health care payers, providers, and certified IDR entities by establishing new timelines and processes. When the individual requirements in these final rules will take effect will vary depending on when the technical capacity to support them is ready within the not-yet-introduced [...]

joe2026-08-12T13:05:25-04:00August 13, 2026|Uncategorized|

AHRQ Pulls Back Research Funding

Many groups that were awarded multi-year grants by the Agency for Healthcare Research and Quality are now being informed that they will not be receiving the additional funding they were told they could expect. In letters it is sending to such organizations, AHRQ is informing them it is not providing additional funding because its priorities have changed. Specifically, the letters explain that AHRQ's current priorities include focusing agency resources on patient safety, preventing antibiotic resistance, telehealth, overmedication of children, use of digital health tools to improve health, long COVID, artificial intelligence, nutrition, furthering understanding of autism, promoting research focused on [...]

joe2026-07-30T16:58:58-04:00August 3, 2026|Uncategorized|

SAMHSA Reports on the State of the American Mind

The Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration has released its 2025 National Survey on Drug Use and Health, its primary source of data on how Americans report their experience with mental health conditions, substance use and addiction, pursuit of treatment, and recovery. This year’s survey presents five years of data examining trends among key substance use and mental health outcomes. SAMHSA presents its findings are declines as increases in the prevalence of various behaviors, including: mental health substance use suicidal thoughts and behaviors non-suicidal self-harm substance use treatment services mental health treatment [...]

joe2026-07-28T16:55:39-04:00July 30, 2026|Uncategorized|

Agency Seeks Confidential Accident Data From Hospitals

The Consumer Product Safety Commission is seeking to require some hospitals to participate in its National Electronic Injury Surveillance System (NEISS), the nation's principal system for tracking consumer product-related injuries. Currently relying on manual review and coding of medical records from roughly 70 of the nation's more than 5,000 hospital emergency departments, the agency has announced that it will expand its surveillance network across all 50 states and to about 100 hospitals and health systems. Under the updated program, NEISS-R would exchange data with participating hospitals through federally designated Qualified Health Information Networks in an effort to strengthen the CPSC’s ability to detect product hazards. It would search for [...]

joe2026-07-28T14:36:16-04:00July 29, 2026|Uncategorized|

Developments in No Surprises Act/Independent Dispute Resolutions

Recent weeks have seen several developments and new information in the use of the No Surprises Act’s independent dispute resolution process for health care billing disputes between payers and providers over out-of-network care. The number of disputes directed to independent dispute resolution continues to rise – 16 percent more during the second half of 2025 than during the first half of that year. Providers continue to initiate about three-quarters of the disputes and to win about 85 percent of those cases. Most of the provider-driven disputes are intiated by small provider groups, many of them represented by just a few [...]

joe2026-07-23T15:42:59-04:00July 27, 2026|Uncategorized|

What the Health Care Industry Wants From AI

Guidance on creating and implementing governance structures. Tools for evaluating and benchmarking potential AI tools. Coordination of AI strategy across government health care agencies. Last year, the Department of Health and Human Services issued a request for information in which it asked health care industry interests what they wanted from the federal government to facilitate their use of artificial intelligence in running their organizations and caring for their patients. Their answers? Guidance on creating and implementing governance structures. Tools for evaluating and benchmarking potential AI tools. Coordination of AI strategy across government health care agencies. Learn more about what [...]

joe2026-07-08T11:59:24-04:00July 10, 2026|Uncategorized|

States Sue Feds Over Medicaid Work Requirements

Twenty-five states have sued the federal government in response to the interim final rule published by the Centers for Medicare & Medicaid Services to implement the enhanced work and community engagement requirements for Medicaid eligibility established in H.R. 1, last year’s federal budget reconciliation law. H.R. 1 calls for tougher standards for Medicaid eligibility, including a mandate that most Medicaid participants either work or are engaged in some form of approved community engagement, such as attending school or participating in volunteer work. But the 25 states – all with Democratic governors and attorneys general – claim that CMS’s implementation of [...]

joe2026-06-30T15:49:37-04:00July 1, 2026|Uncategorized|

Remake of Organ Donation Process Continues

The current effort to remake the organ donation process is moving toward a critical juncture. The overhaul, launched more than two years ago as the “Organ Procurement and Transplantation Network Modernization Initiative,” has now moved to the stage where the organizations that facilitate organ donations in the future will be decided. The current plan, which seeks to boost the quantity of donated organs to meet national needs, is to identify and keep the highest performers among the current group of organ procurement organizations, revoke the certification of the weakest of the current performers, and invite organizations to compete for the [...]

joe2026-06-24T12:53:53-04:00June 25, 2026|Uncategorized|

States Finding Rural Transformation Money Comes With Strings

While the Centers for Medicare & Medicaid Services has announced grant awards to states under the Rural Health Transformation program, agency regulators have made it clear that they are prepared to take back some of that money if they do not like how a state’s planning is proceeding. Despite the federal approval of program funding, regulators continue to work with state Medicaid officials to mold their proposed programs to bring them into greater alignment with administration health care objectives. In some cases, states have already modified their plans in response to CMS feedback. According to one published report, CMS administrator [...]

joe2026-06-23T17:28:57-04:00June 24, 2026|Uncategorized|