EDPMA fully supports the No Surprises Act and its patient protections.
We believe keeping patients out of the middle of payment disputes for out-of-network care is the right thing to do. We also believe in the balanced framework the law provided after years of discussion, debate, and bipartisan cooperation.
However, the regulations that were written to implement the law substantially altered the balances carefully crafted by Congress. Thus, these new imbalances are significant, are inconsistent with the law, and most importantly, the health care system is now threatened by the results. Compounded by health care workforce constraints, inflation, and a Medicare fee schedule that has not kept pace with inflation, the activities of commercial health insurers based on the No Surprises Act (NSA) are impacting the ability of medical practices to provide timely patient care.
Since 2021, EDPMA and others have consistently identified and offered solutions to fix the flawed implementation of the No Surprises. In 2023, EDPMA launched the NSA Implementation Tactical Task Force (I-Tact) to bring together diverse members to identify and provide practical solutions to not only fix the No Surprises Act, but to also preserve patient access to timely care. I-Tact’s Work Groups focuses on NSA compliance, IDR and IDRE compliance and legislative/regulatory fixes.
I-Tact in Action
Each I-Tact Work Group meets twice a month plus the I-Tact Standing Committee meets monthly. I-Tact’s singular focus on fixing the No Surprises Act results in consistent actions aimed at regulators and Congressional leaders to protect patients and the practice of emergency medicine.
EDPMA Regulatory and Legislative Advocacy to Fix Implementation of the No Surprises Act
- 09.14.24 – EDPMA issues a press release fully supporting H.R. 9572, the No Surprises Act Enforcement Act.
- 08.20.24 – EDPMA Outlines Concerns About QPA Reliability to IDREs
- 07.29.24 – EDPMA and ACEP Urge the Departments to Issue Immediate Guidance to IDREs to Ensure Accurate QPA Calculations
- 06.14.24 -EDPMA Win! EDPMA’s vigorous advocacy to CMS and CCIIO to provide flexibilities for members affected by the Change Healthcare cyberattack and related outages paid off. CMS announced IDR 120-calendar-day open negotiation flexibility for entities affected by the Change Healthcare outage.
- 06.14.24 – EDPMA Win! EDPMA advocated to the Center for Consumer Information and Insurance Oversight (CCIIO) to reach out to Independent Dispute Resolution Entities (IDREs) regarding IDREs rejection of batches on disputes held together in the same 90-day cooling off period. CCIIO confirmed they communicated with IDREs “to clarify the items and services delivered during the same 90-day cooling off period that meet all applicable batching requirements may be included in the same batch. “
- 04.02.24 – EDPMA and ACEP Ask For Clarification and Flexibilities in the Federal IDR Process in Response to the Change Healthcare Cyberattack
- 03.01.24 – Change Healthcare Cyberattack: EDPMA Urges Government To Protect Emergency Medicine Physician Practices
- 03.01.24 – Change Healthcare Cyberattack: EDPMA Advocates on Capitol Hill
- 02.26.24 – EDPMA and ACEP Urge The Tri-Departments to Address Health Plans Changing The Patient Cost-Sharing Amounts Post -IDRE Payment Determination
- 01.29.24 –EDPMA and ACEP Reiterate our December 21 comments and add a fine-point to enforcement and effective dates.
- 12.21.23 – EDPMA and ACEP Comments on the Federal Independent Dispute Resolutions Operations Proposed Rule
- 12.12.23 – EDPMA Urges The Departments To Add 40 Days To File Batched Disputes When The Federal IDR Portal Opens
- 11.11.23 – EDPMA and ACEP Initial Response to Federal IDR Operations Proposed Rule
- 10.26.23 – EDPMA and ACEP Letter on the IDR Fee Proposed Rule
- 10.09.23 – Joint Statement on Portal Re-Opening
- 10.02.23 – EDPMA’s Statement For the Record, House Committee on Ways and Means
- 09.15.23 – EDPMA Recommendations To Fix The NSA
- 08.11.23 – EDPMA Concerned About IDR Portal Freeze After TMA II Ruling
- 07.10.23 – EDPMA and ACEP HELP Roundtable on NSA Follow-up
- 02.13.23 – EDPMA and ACEP Letter To Fix the IDR Admin Fees
- 01.19.23 – EDPMA and ACEP Follow Up To Fix the No Surprises Act
- 11.28.22 – EDPMA and ACEP Request To Require RARC Codes Under the No Surprises Act
- 06.21.22 – EDPMA and ACEP Identify Issues and Solutions Re: Surprise Billing First IFR
- 04.25.22 – EDPMA and ACEP Offer More Feedback to the IDR Portal
- 03.22.22 – EDPMA and ACEP Offers Feedback on the IDR Portal
- 12.06.21 – EDPMA and ACEP Comment on Surprise Billing, Part 2
- 11.11.21 – EDPMA and ACEP Identify Issues and Solutions: IDR Part 2
- 08.31.21 – EDPMA and ACEP Comment on Surprise Billing Part I IFR
- 08.10.21 – EDPMA and ACEP Identify Issues and Solutions to IDR Rulemaking
- 06.16.21 – EDPMA and ACEP Letter to OMB Regarding No Surprises Act Implementation
- 05.14.21 – EDPMA and ACEP Technical Comments on the No Surprises Act Implementation
- 03.24.21 – EDPMA and ACEP Comment on the Impact of the No Surprises Act on Emergency Care