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On January 17, 2024, the Departments of Health and Human Services, Labor, and the Treasury (collectively, the “Departments”) and the Office of Personnel Management issued a notice that they will reopen the period for submitting comments on the proposed rule, “Federal Independent Dispute Resolution (IDR) Operations” (the “Proposed Rule”) under the No Surprises Act (the “Act”).

The Proposed Rule would establish new requirements for the disclosure of information that group health plans and health insurance issuers offering group or individual health insurance coverage must include along with the initial payment or notice of denial of payment for certain items and services subject to the surprise billing protections in the Act. The Proposed Rule would:

  • Require plans and issuers to communicate information by using claim adjustment reason codes (“CARCs”) and remittance advice remark codes (“RARCs”), as specified in guidance, when providing any paper or electronic remittance advice to an entity that does not have a direct or indirect contract with the plan or issuer.
  • Amend certain requirements related to the open negotiation period preceding the Federal IDR process, the initiation of the Federal IDR process, the Federal IDR dispute eligibility review, and the payment and collection of administrative fees and certified IDR entity fees.
  • Define bundled payment arrangements, amend requirements related to batched items and services, and amend the rules for extensions of timeframes due to extenuating circumstances.
  • Require plans and issuers to register in the Federal IDR portal.

The original comment period closed on January 2, 2024. It will be reopened from the date the reopening of the comment period is published in the Federal Register (which is expected to be on January 22, 2024) to 14 days after that date.

You can find more information regarding the Act on the Sheppard Mullin Healthcare Blog.