Here's are recent updates to the No Surprises Act and changes expected in 2025:
1. An August report from CMS detailed the most common complaints related to No Surprises Act and ACA compliance. These complaints include surprise billing for both emergency and non-emergency services by providers, payment noncompliance by payers and late payments after independent dispute resolution determination.
2. In September, a bill was introduced in the House of Representatives to improve No Surprises Act enforcement. The bill would increase penalties for non-compliance of statutory payment deadlines, provide parity between penalties imposed against parties that are non-compliant with statutory patient protection provisions and increase the transparency of reporting requirements.
3. President Biden's 2025 budget includes an additional $500 million over the next five years to expand the No Surprises Act to include ground ambulance services. This would allow lawmakers to revisit and address the payment resolution process for these services.
4. Updates in 2025 also include a proposal to streamline the IDR administrative fee collection process. Departments would collect the administrative fees directly from the disputing parties, rather than having the separate IDR agency collect the fees. This would require the initiating party to pay their administrative fee within two business days after the IDR entity selection, while the non-initiating party would pay within two days of the notice of receiving the IDR eligibility determination.
Failure to pay by the initiating party results in the dispute being closed and neither party will owe a fee. If the non-initiating party does not pay the administrative fee, the party's offer would not be considered received. The rule change proposed to charge both parties a reduced fee for low dollar disputes when the highest offer made in negotiations was less than a predetermined threshold.
5. These are the proposed administrative fees for 2025:
- Full administrative fee per party per dispute would be $150.
- Reduced administrative fee for low-dollar disputes would be $75 for both parties.
- Reduced administrative fee for non-initiating parties in disputes found ineligible for IDR would be $30.
6. Proposed changes in 2025 will also include a requirement that payers subject to the IDR process register with federal departments and provide general information regarding the applicability of the IDR process to items or services covered within the plan.
7. The proposal also includes new requirements to determine IDR eligibility, including the use of CARC and RAR codes to address concerns that numerous claims were filed through the IDR process and have since been proven ineligible, wasting administrative time and resources.
8. On Sept. 27, the American Association of Nurse Anesthesiology filed a petition with a U.S. district court urging Xavier Beccera, Secretary of Health and Human Services, to enforce the provider nondiscrimination provision of the Affordable Care Act against insurance companies and health plans.
9. The nondiscrimination provision was passed in 2010 to prevent payers from discriminating against providers on the basis of licensure. The 2020 No Surprises Act required HHS to enforce those policies within one year, but the AANA contends there is still no enforcement in place.
10. The Federation of American Hospitals, the American Medical Association and the Texas Medical Association filed an amicus brief Oct. 7, urging the 5th Circuit U.S. Court of Appeals to reverse a judge's ruling that rendered decisions made under the No Surprises Act "unenforceable."