UPDATE: On May 30, 2025, the Fifth Circuit granted the TMA III plaintiffs’ petition for rehearing en banc, which was previously filed on December 16, 2024. Of note, the Fifth Circuit’s mandate has not yet been issued, so as a technical matter, it never changed the District Court’s holding in TMA III. Accordingly, pending the results of the rehearing en banc, which could take approximately one year, there should be no material changes to the IDR process. CMS’s prior guidance, ACA & CAA FAQ Pt 69, which we wrote about below, also contemplated the potential for the en banc hearing and provides that pending the Fifth Circuit’s mandate being issued, consistent with FAQs Part 62 and the District Court’s ruling, plans and issuers can continue to rely on any QPAs that have already been calculated using a good faith, reasonable interpretation of the 2023 methodology. Note content updated June 4, 2025.
The No Surprises Act (NSA) went into effect on January 1, 2022. It bars surprise billing in several healthcare settings and establishes new transparency requirements. Under the law, providers, including hospitals, facilities, individual practitioners and air ambulance providers, are prohibited from billing patients more than in-network cost-sharing amounts in specified circumstances. The prohibition applies to emergency care and certain non-emergency situations where patients do not consent to an out-of-network provider. The NSA also creates independent dispute resolution processes for resolving payment disputes between plans and issuers on the one hand and providers on the other.
This resource center shares our insights on the implementation of the NSA, including how new regulations, guidance, litigation and more impact healthcare organizations, including in their capacities as sponsors of employee health and wellness plans. McDermott advises healthcare organizations on the following:
- Independent dispute resolution process
- Good faith estimate requirements
- State laws related to surprise billing
- NSA compliance requirements for employee benefit plans
- Managing potential liability
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