It seems a fresh wave of regulatory intervention is on the horizon, and it potentially carries a strong financial punch. On September 26, 2023, the Departments of Health & Human Services (HHS), Labor, and the Treasury, put forward a joint proposal to update the administrative fee and Certified Independent Dispute Resolution (IDR) entity fee ranges for the Federal IDR Process under the No Surprises Act.
This latest rule, dubbed the ‘September Rule’, proposes a fee increase from $50 to $150. If it’s accepted, the new fee will take effect on January 1, 2024, post a notice and comment period. The deadline for comments on the rule has been set for October 26, 2023.
The No Surprises Act is a significant piece of legislation, aiming to shield consumers from excessive out-of-network healthcare costs. The Federal IDR Process, to which the proposed fee increase relates, is a key tool for dispute resolution in regard to ‘surprise’ billing disputes between providers and health insurers.
The September Rule, if implemented, will undoubtedly impact both health care providers and insurers. With the proposed increase in IDR entity fees, it will become more expensive to engage in IDR processes. This could influence strategies and decisions around how often and in what situations providers choose to use IDR as a dispute resolution method
The proposed revisions within the September Rule illustrate the dynamic and often challenging regulatory landscape navigated by legal professionals in the health care sector. It also serves as a reminder of the importance of staying up-to-date and engaged with such proposed changes in order to evaluate and anticipate their impact.
This report has been based on a detailed review of a recent article outlining the proposed changes and their implications, which can be found on JD Supra. Legal professionals are encouraged to further explore the nuances of the proposed changes on the original site, and perhaps make a note to share their thoughts prior to the October 26 deadline for public comments.