No Surprises Act Guidance for Health Plans: Final Rules, IDR Process, Qualifying Payment Amounts, Disclosures

The NSA, enacted as part of the Consolidated Appropriations Act of 2021, was initially implemented through interim final rules and later through final rules addressing core provisions such as surprise billing protections, patient disclosures, notice and consent, and the Qualifying Payment Amount (QPA) methodology. Since then, the regulatory landscape has been significantly reshaped by ongoing litigation, particularly the series of Texas Medical Association (TMA) decisions. These rulings have altered how the QPA is calculated and applied. The ripple effects have disrupted the structure of the federal IDR framework, which continues to experience high dispute volumes and operational strain. At the same time, regulators have placed renewed emphasis on disclosure and cost-sharing requirements. 

Given this unsettled environment, benefits counsel and plan administrators must understand both the statutory baseline and the evolving agency interpretations to ensure compliance. 

Listen as our panel discusses surprise billing prohibitions, notice and consent requirements, and the payment process under the NSA. The panel will also discuss the qualifying payment amount and IDR processes under the final rules.