No Surprises Act

Federal Health Policy Update for August 20

Don’t Miss: Latest No Surprises Act/Independent Dispute Resolution news Dept of Homeland Security issues guidance on “public charge” The following is the latest health policy news from the federal government for August 14-20. Some of the language used below is taken directly from government documents. Congress Thirty Senate Democrats have written to HHS Secretary Kennedy seeking to reverse the cancellation of health research grants administered by the Agency for Healthcare Research and Quality (AHRQ). For more information, see the letter here. Congress remains in recess; the House is expected to return on August 31 and the Senate on September 14. [...]

joe2026-08-20T15:55:42-04:00August 20, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

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|

Federal Health Policy Update for August 13

Don’t Miss: Federal court vacates key aspect of No Surprises Act’s IDR process President calls for changes in childhood immunizations CMS seeks billing info so it can pay APM docs their bonuses The following is the latest health policy news from the federal government for August 7-13. Some of the language used below is taken directly from government documents. The White House The White House has issued an executive order calling for a change in recommended childhood vaccines. The order suggests reducing the number of recommended childhood vaccines from the current 17 to 11 revising the status of the remaining [...]

joe2026-08-13T14:39:23-04:00August 13, 2026|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

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|

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|

Federal Health Policy Update for July 23

Don’t Miss: Congress advances health care bills CMS proposes provider tax rule Courts act on ACA changes, 340B The following is the latest health policy news from the federal government for July 17-23. Some of the language used below is taken directly from government documents. Congress The House Energy and Commerce Committee held a markup for 29 bills, advancing the following health care transparency measures with bipartisan support: H.R. 9390, Prices on the Wall Act of 2026 H.R. 9393, Lower Costs, More Transparency Act of 2026, part of a package that also includes: H.R. 3514, Improving Seniors’ Timely Access [...]

joe2026-07-23T16:29:15-04:00July 23, 2026|340b, Affordable Care Act, MACPAC, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for July 16

Don’t Miss: CMS proposed 2027 physician payment regulation House Ways and Means passes health care bills DHS publishes new, final public charge rule HHS pursues delivery models for potential psychedelic drugs for behavioral health treatment The following is the latest health policy news from the federal government for July 10-16. Some of the language used below is taken directly from government documents. CMS – Proposed 2027 Medicare Physician Fee Schedule Rule CMS has published its proposed physician fee schedule rule for 2027. Highlights include: A proposed reduction in Medicare physician rates. A reduction of payments for evaluation and management (E/M) [...]

joe2026-07-16T16:13:25-04:00July 16, 2026|340b, Accountable Care Organization, ACO, Alternative payment models, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for June 18

Don’t Miss: 340B Rebate Model pilot program – next steps Stricter rules on CMS’s reviews of new and existing section 1115 Medicaid demonstration programs Changes in health care institution accrediting practices HHS posts mental and behavioral health grant opportunities The following is the latest health policy news from the federal government for June 12-18. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress will return to session on June 22. The House Energy and Commerce Committee’s Oversight and Investigations Subcommittee will hold a hearing titled “State Medicaid Program Integrity: Examining Fraud Risks [...]

joe2026-06-18T16:07:51-04:00June 18, 2026|340b, Affordable Care Act, Alternative payment models, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for May 28

The following is the latest health policy news from the federal government for May 22-28. Some of the language used below is taken directly from government documents. Congress When Congress returns from the Memorial Day recess next week, lawmakers will have to address the Republican-led reconciliation bill to fund ICE and CBP. After, they plan to start working on a third party-line bill focusing on affordability—including health care—which leadership aims to pass by the end of July. Next week, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is scheduled to mark up its Fiscal [...]

sysadmin2026-05-28T17:43:32-04:00May 28, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicare, Medicare regulations, Medicare reimbursement policy|

No Surprises Act Activity in 2025

A new Health Affairs report offers a preliminary look at No Surprises Act Independent Dispute Resolution activity for 2025. Among its findings: Providers and facilities initiated 99.9 percent of the disagreements submitted to the IDR process. Four provider groups or representatives of provider groups initiated more than half of those cases. Providers prevailed in 88 percent of the cases. Health plans challenged 40 percent of the cases submitted to the IDR process as ineligible for adjudication under that process. The IDRs upheld their challenges only 17 percent of the time. Health plans are starting to sue those submitting large numbers [...]

joe2026-03-24T16:48:35-04:00March 25, 2026|Uncategorized|