OIC Asks for Feedback on Balance Billing Law & Federal Court Puts Hold on No Surprises Act Arbitration

August 16, 2023

WSHA recently responded to a request for information regarding whether the state Office of the Insurance Commissioner should extend the state’s own dispute resolution process under the state’s Balance Billing Protection Act (BBPA).  Currently the BBPA provisions and mechanism are scheduled to expire at the end of 2023. WSHA recommended the BBPA mechanisms be extended due to the continuing issues and backlogs with the federal NSA IDR process.

On August 3, 2023, the federal No Surprises Act (NSA) Independent Dispute Resolution (IDR) process was suspended following the U.S. District Court decision in Texas Medical Association, et al. v. United States Department of Health and Human Services. Policies that were vacated by the court ruling include changes limiting the ability of providers to combine similar claims in a single arbitration and an increase to the arbitration fee from the previous $50 to $350. The combination of the two changes made it economically prohibitive for many providers to initiate the IDR process.

On August 11, CMS announced that it would restore the $50 amount for IDR claims after August 3 until a new amount is established, but the $350 will remain in place for IDR cases initiated between January 1 and August 2, 2023. The IDR process remains suspended due to the other issues identified by the court that are yet to be resolved. At this time, it is unclear when the federal IDR process will resume. (Andrew Busz, andrewb@wsha.org)


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