This update is in regards to the most recent extension that CMS has granted. All parties seem to be having a problem with submission. In response to these issues CMS has said the following:
We are aware that some disputing parties are having issues submitting their completed Notice of Offer web form. The IDR Development team is triaging to identify the root cause and resolution.
Until then, FHAS encourages all parties to attempt submission, (but if you are unable) you will receive further guidance from CMS/FHAS on how to proceed. Before you attempt submission be sure that your dispute qualified for the extension:
To have been granted this extension the dispute must be a single or bundled claim, as well as have an offer due date land from 8/24/2023 to 9/21/2023. Entities are not able to work batched disputes at this time.
There are no other updates at this time.
Per the last Updated: TMA III & IV Ruling: How to Proceed…
As of September 21st 2023, CMS has released the following updates:
On August 24, 2023, the U.S. District Court for the Eastern District of Texas issued an opinion and order in Texas Medical Association, et al. v. United States Department of Health and Human Services, Case No. 6:22-cv-450-JDK (TMA III), vacating certain portions of 86 Fed. Reg. 36,872, 45 C.F.R. § 149.130 and 149.140 , 26 C.F.R. § 54.9816-6T and 54.9817-1T, 29 C.F.R. § 2590.716-6 and 2590.717-1, and 5 C.F.R. § 890.114(a) as well as certain portions of several guidance documents. As a result of the TMA III decision, effective immediately, the Departments have temporarily suspended all Federal IDR process operations until the Departments can provide additional instructions. Disputing parties should continue to engage in open negotiation.
The Federal Independent Dispute Resolution (IDR) process remains temporarily suspended. Disputing parties are unable to initiate new disputes. Effective September 5, 2023, certified IDR entities can resume determining eligibility and conflicts of interest (COI) for single and bundled disputes submitted on or before August 3, 2023. However, certified IDR entities should not update the Federal IDR portal with results of their eligibility and COI determinations in order to avoid triggering the Notice of Offer/offer submissions process, which remains on hold pending further guidance from the Departments. Certified IDR entities may reach out to disputing parties for any needed information in order to make a COI or eligibility determination. All other parts of the process remain on pause; parties should not be asked to pay fees or submit an offer in relation to any eligible disputes.
The latest update was sent on September 21st, 2023:
Due to the TMA III court ruling on 08/24/2023, the Federal Independent Dispute Resolution (IDR) portal and all IDR web forms were temporarily unavailable.
This evening, Federal IDR portal access will be restored to certified IDR entities for all single and bundled disputes in the Notice of Offer or Payment Determination phases of IDR. It is critical that certified IDR entities follow the guidance below for resuming operations on 9/21/2023.
The TMA III order vacated certain provisions of the regulation establishing the methodology for calculating the Qualifying Payment Amount (QPA). The Departments issued guidance on how to proceed with disputes following the court’s order,
[FHAS has also attached this guidance below for your convenience.]
Payment disputes between providers and health plans | CMS
With all of this new information entities are able to do the following:
Entity Capabilities:
Entity Incapabilities:
Other important notes:
FHAS will continue to update as we find out new information.
If you have questions feel free to comment on this post, email us at IDRE@fhas.com or call FHAS at (570) 779-5122 and ask for our IDR department. Thank you.