0938-AV15 202504 Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Independent Dispute Resolution Operations (CMS-9897)

This document finalizes rules related to certain provisions of the No Surprises Act regarding the Federal independent dispute resolution (IDR) process, which was established as part of the Consolidated Appropriations Act, 2021 (CAA). This rule sets forth new requirements relating to 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 No Surprises Act. This rule also requires 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 contractual relationship with the plan or issuer. This document also amends 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. This document also defines bundled payment arrangements, amends requirements related to batched items and services, and amends the rules for extensions of timeframes due to extenuating circumstances. Additionally, this document requires plans and issuers to register in the Federal IDR portal.

]]> Economically Significant Previously Published in The Unified Agenda Final Rule Stage Yes Undetermined Regulatory 5 CFR 890 26 CFR 54 29 CFR 2590 45 CFR 149 Pub. L. 116-260, Division BB, title I & title II No NPRM 11/03/2023 88 FR 75744 NPRM Comment Period End 01/02/2024 NPRM Comment Period Reopened 01/22/2024 89 FR 3896 NPRM Comment Period Reopened End 02/05/2024 Final Action 11/00/2025 YES Businesses Federal State Undetermined Yes No 1210 Employee Benefits Security Administration EBSA Joint 1545 Internal Revenue Service IRS Joint 3206 Office of Personnel Management OPM Joint Bryan Kirk Deputy Director, Division of Independent Dispute Resolution 0938 Centers for Medicare & Medicaid Services CMS 301 492-4122 bryan.kirk@cms.hhs.gov Center for Consumer Information and Insurance Oversight , 7500 Security Boulevard, Baltimore MD 21244