Revamp of The No Surprises Act Federal Independent Dispute Resolution Process
By Jake Walker
One of the most scrutinized aspects of the No Surprises Act has been the Federal Independent Dispute Resolution (“IDR”) process. According to data published by The Centers for Medicare and Medicaid Services (“CMS”), the number of disputes initiated between April 15, 2022, and May 31, 2026, was 6,336,0321. Of those disputes, 1,066,645 were found to be ineligible and 208,020 were closed due to other events (e.g., withdrawn by disputing parties, outside settlement, administrative closures)2. The total volume of disputes far exceeded initial projections by the relevant agencies, creating significant backlogs in the Federal IDR process.
As a result, the U.S. Department of Health and Human Services (“HHS”) (along with the Department of Labor and Department of the Treasury) (collectively, the “Departments”) published a final rule on June 4, 2026, addressing particular aspects of the Federal IDR process including issues with timely rendering of payment determinations, enhancing information sharing between relevant actors, and introducing clearer timeframes for certain steps in the Federal IDR process (the “Final Rule”)3. The Final Rule is effective August 3, 2026, with staggered applicability dates for specific provisions (as shown in the table provided below). The Final Rule represents the most comprehensive revision to the Federal IDR process since its establishment.