BENEFITS DIGEST

HaloMD claims the No Surprises Act has cut out-of-network emergency spending by 13% to 52%, saving $1 billion to $4 billion a year. Independent researchers are skeptical. The study leans on assumptions rather than actual payment data, ignores the cost of running the arbitration system, and comes from a company that files about a quarter of all arbitration claims itself. Worth knowing before this number shows up in a policy fight.

Proskauer breaks down the en banc Fifth Circuit's August 11 decision rejecting the government's qualifying payment amount methodology under the No Surprises Act. The court held that ghost rates, meaning contracted rates for services a provider never actually furnishes, must be excluded from the QPA, that bonus and incentive payments must be included because the statute's reference to total amounts means the entire amount owed, and that one-off single-case agreements stay out. Payors should watch for agency guidance on how QPAs get recalculated.

On August 11 the en banc Fifth Circuit affirmed the district court's vacatur of key portions of the departments' qualifying payment amount methodology in Texas Medical Association v. HHS, the rules governing how plans calculate the benchmark rate that anchors No Surprises Act payment disputes. (Separately, the tri-agencies' July guidance specifying required remittance advice remark codes for No Surprises Act claims takes effect November 1, with mandatory use for items and services furnished on or after January 1, 2027.)

ERIC's read of the Georgetown research puts No Surprises Act arbitration costs at $22.4 billion over four years, with filings up 77 percent year over year and providers winning roughly 85 percent of disputes at awards well above median in-network rates. The employer lobby wants Congress to recalibrate the IDR process, arguing plans and workers ultimately absorb the pressure.

Researchers estimate that independent dispute resolution has created $22 billion in unnecessary spending. But that estimate is flawed, argue associations representing anesthesiologists, radiologists and ER doctors.

Accelerating dispute volumes and sky-high award amounts are inflating how much independent dispute resolution is costing the U.S., according to new Georgetown research. Patients could pay the price with higher premiums.

The 2026 regulations standardize claim communications, restructure open negotiation, clarify batching rules, and impose tighter deadlines for determining IDR eligibility. Self-funded plans must register.

Akerman breaks down what TMA III actually struck from the QPA methodology: ghost rates, bonus and incentive payments, and the treatment of single-case agreements, and what health plans and insurers should do while the Departments draft replacement guidance.

The Departments posted a statement confirming that the Fifth Circuit's August 11 en banc decision in Texas Medical Association v. HHS affirmed portions of a district court judgment striking certain regulations and guidance on how the qualifying payment amount is calculated. The Departments say they are reviewing the opinion and anticipate issuing guidance shortly, and that the Federal IDR process remains operational. Until that guidance issues, the QPA methodology the rules prescribed has no replacement.

The Departments released a timeline guide fixing the applicability date for each piece of the June Federal IDR Operations final rules. Two dates matter most for group health plans: the revised batching rules reach disputes whose open negotiation period begins on or after November 1, 2026, and the new remittance advice coding requirements attach to items and services furnished on or after January 1, 2027.

ArentFox Schiff calls TMA III what it is: an important but incomplete provider win. Ghost rates and the bonus exclusion are out of the QPA math, while the agencies held the line on excluding single-case agreements.

DOL's semiannual regulatory agenda, where EBSA rulemakings get sequenced. The notable thing is how empty it is: the EBSA section carries exactly one entry, the IDR Operations rule, and that rule was already finalized on June 4. In other words, EBSA currently has no pending rulemaking on the public agenda at all.

The federal IDR process moves from single-use web forms to a centralized IDR Gateway late this year, with account registration opening September 15. Practical note for sponsors: a plan using a TPA does not register itself, but should confirm before September 15 that its TPA holds the administrator role.

Polsinelli confirms the en banc Fifth Circuit's August 11 ruling struck the ghost-rate, out-of-specialty, and bonus-exclusion provisions of the QPA methodology, and maps what the recalculation means for payors and plans.

Healthcare Dive's news coverage of the TMA III ruling that led Friday's Digest: ghost rates and bonus exclusions are out of QPA math, and payouts to providers are set to rise.

Groom reviews CMS's newly announced updates to federal IDR operations and the dispute portal under this year's final rule, a companion read to the implementation timeline guide the Departments released last week.

Get compliance insights on the new IDR Gateway, RARC code requirements and next steps for group health plan sponsors.

The Departments of Health and Human Services, Labor, and the Treasury (Departments) recently released the Federal Independent Dispute Resolution (IDR) public use files (PUF) and supplemental tables for the third and fourth quarters of 2025.

On 5/28/26, the Departments of Health and Human Services, Labor, and the Treasury released final rules modifying the Federal independent Dispute Resolution Operations

Turquoise Health has launched a new dashboard that provides free tracking of independent dispute resolution (IDR) awards from disputes over services covered by the No Surprises Act.

It's the third recent legal victory in No Surprises lawsuits for billings intermediary HaloMD, which has also had suits dismissed in California and Texas.