Regulators Must Restart Federal IDR Process Immediately
New guidance for certified IDR entities necessary to prevent meltdown of healthcare system
FOR IMMEDIATE RELEASE
February 22, 2023
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WASHINGTON — On the heels of Texas plaintiffs' second win in court against federal agencies regarding the No Surprises Act (NSA), the Centers for Medicare & Medicaid Services (CMS) has issued a new notice.
This update adds further uncertainty to the federal independent dispute resolution (IDR) process that has been plagued by dysfunction. CMS writes:
"As a result of 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 on or after February 6, 2023."
Instead of swiftly adhering to the decision from the U.S. District Court for the Eastern District of Texas and immediately issuing new guidance, freezing new payment determinations will only exacerbate the current dilemmas:
According to CMS' initial IDR report, 90,078 IDRs were filed in less than six months last year. In a massive miscalculation, the agencies estimated that -- each year -- only 17,333 IDRs would be filed. This log-jam is building by the day.
There are only 13 certified IDR entities (IDREs) for the entire country. This number of organizations is woefully insufficient, and in direct defiance of the law. The NSA states that the agencies "shall ensure that a sufficient number of entities are certified...to ensure the timely and efficient provision of determinations."
Reports that physicians have not received any IDR claim compensation for all of last year, thanks not only to health plans refusing to pay, but also CMS' refusal to enforce payment determinations.
Commenting on CMS' notice, Action for Health President Christopher Sheeron issued the following statement:
"If CMS takes another six months to provide new guidance, just like it did after its first court loss in TMA I, we will be looking at a total meltdown of healthcare delivery in our country. The federal IDR process is broken, and health insurance companies are reveling in this fact.
"The No Surprises Act was enacted 26 months ago. It's incomprehensible that we are now staring down the barrel of a complete failure to implement such a milestone law. It's high time for the IDR process to proceed in the time frames set forth in the statute. If a functioning IDR process is not up and running immediately, patients nationwide will have far fewer medical practices open to care for them."