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Policy Updates

9-06-23 Update: TMA III & IV Ruling – How to Proceed

By September 6, 2023March 13th, 2024No Comments

On August 29th, 2023, FHAS provided the following language published by CMS on their portal:

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.

On September 6, 2023, CMS had a meeting with all the entities to give the following update:

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. 

FHAS is currently working on eligibility determinations internally. You might begin to see additional information requests from the entities since this is now allowed. Although we can request and receive documents – we will not be sending invoices or offer links. This includes previously sent links and invoices. We are unable to provide this according to the current limitations set by the departments.

In summary:

Entity Capabilities:

  • Determining eligibility internally.
  • Requesting additional information in order to determine eligibility.

Entity Incapabilities:

  • Requesting payment.
  • Requesting offer.
  • Sending invoices and links that were requested before the hold.
  • Closing disputes for ineligibility.
  • Providing documents uploaded to the portal.
  • Making determinations.
  • Processing withdrawals.
  • Status updates.

FHAS will continue to update as we find out new information.

If you have questions feel free to email or call FHAS at (570) 779-5122 and ask for our IDR department.

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