The arbitration process for surprise billing disputes will remain operational despite the ongoing government shutdown, according to the Centers for Medicare & Medicaid Services (CMS). As of Friday, parties involved in disagreements over out-of-network claim reimbursements can continue to submit disputes through the federal independent dispute resolution (IDR) portal. The agency confirmed that arbitrators will keep processing these disputes, ensuring that the provisions of the No Surprises Act remain in effect for now.
The shutdown commenced on midnight on September 30, 2023, after lawmakers failed to agree on extending funding for Affordable Care Act plans. This lapse in appropriations has halted many government operations, particularly affecting the Department of Health and Human Services (HHS) and its subagencies. Despite these challenges, the CMS has reassured stakeholders that the IDR process, which is funded by administrative fees from payers and providers, will not face immediate disruption.
While the IDR process is secure, other activities related to surprise billing may encounter delays. According to Jeffrey Davis, health policy director at McDermott+, investigations into surprise billing complaints that fall outside the IDR framework may be impacted. He noted that oversight and enforcement efforts, as well as various implementation tasks, could also face setbacks due to the funding lapse.
In its notice released on Friday, the CMS indicated that a prolonged shutdown could lead to delays in reviewing and processing IDR complaints. It also warned that response times to inquiries might be affected. Davis highlighted that a clean continuing resolution bill, passed by the House on September 19, 2023, aimed to allocate $15 million to support these activities but failed to secure Senate approval before the shutdown.
Despite some progress in clearing the backlog of surprise billing disputes, many industry stakeholders express concerns over the CMS’s response times. There are calls for stronger enforcement to ensure that insurers expedite payment of claims once disputes are resolved. The agency’s shutdown plan has also raised concerns about potential delays in rulemaking processes, which could impact the broader implementation of the No Surprises Act.
The final rule clarifying certain IDR operations was originally scheduled for release in November 2023. Davis remarked that the current situation offers yet another chance for processes to become congested, emphasizing the need for timely action. As the situation develops, stakeholders will be closely monitoring how the shutdown affects both the arbitration process and the overall enforcement of surprise billing regulations.
