Text of Agency ACA FAQs Part 71: No Surprises Act in Light of the Court Decision in TMA III, and Limitations on Cost Sharing Under the ACA (PDF)

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Text of Agency ACA FAQs Part 71: No Surprises Act in Light of the Court Decision in TMA III, and Limitations on Cost Sharing Under the ACA (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Department of the Treasury

[Official Guidance]
July 31, 2025

"[On] May 30, 2025, the Fifth Circuit granted a rehearing en banc, and vacated the Fifth Circuit's October 30, 2024 panel opinion. As a result, the ... district court's decision from August 24, 2023 continues to bind the Departments pending the Fifth Circuit's en banc decision....

Q1: How should plans and issuers calculate a QPA for purposes of patient cost sharing, disclosures with an initial payment or notice of denial of payment, and disclosures and submissions required under the Federal IDR process following the Fifth Circuit's order of May 30, 2025 in TMA III? ...
Q2: How should plans and issuers make disclosures about the QPA to nonparticipating providers, facilities, and providers of air ambulance services with an initial payment or notice of denial of payment, and in a timely manner upon request of the provider or facility? ...
Q3: What is the premium adjustment percentage for the 2026 plan year? ...
Q4: What is the maximum out-of-pocket limit for the 2026 plan year?"

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