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Texas-Based Study Raises Questions About IDR Criteria in No Surprises Act Arbitrations
Healthcare Financial Management Association [HFMA]; free registration required Link to more items from this source
June 22, 2022

"Arbiters in Texas have tended to issue judgments that mirror the median in-network rate even with guidance instructing them to consider other factors.... Initially, [HHS] issued regulations requiring arbiters to primarily consider the median in-network payment amount for a given service in a given market ... HHS has been working on new regulations that purportedly will incorporate [additional] criteria.... [T]he new study calls into question whether such changes will have a substantial effect on outcomes."

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