New Trump Administration rule improves surprise billing protections from the bipartisan No Surprises Act – reversing years of implementation failure and inaction from the Biden Administration.
WASHINGTON, D.C. – After years of Ways and Means Republicans fighting to ensure patients fully benefit from the No Surprises Act, the Centers for Medicare & Medicaid Services (CMS) released a long overdue final rule that improves implementation of the landmark, pro-patient legislation. After losing four separate federal court cases due to its failure to implement the law in alignment with congressional intent, the Biden Administration sat on its hands as payment disputes over surprise bills spiraled out of control. The Trump Administration is succeeding where the Biden Administration failed by finalizing this critical rule, which improves patient access and promotes fair and timely payment by removing arbitrary obstacles to the process for resolving surprise medical bills, known as Independent Dispute Resolution (IDR).
Ways and Means Committee Chairman Jason Smith (MO-08) released the following statement on the Trump Administration’s issuance of the new rule:
“Patients deserve protection from surprise bills for medical services they never agreed to or could have known would be charged, and that’s why Congress passed the No Surprises Act. Unfortunately, the Biden Administration ignored calls to correctly implement the No Surprises law and protect the interests of patients. Thankfully, the Trump Administration has listened to repeated advocacy from Ways and Means Republicans and the American people and acted to implement the law as Congress intended so that patients can receive the full benefits of these policies through timely resolution of surprise medical bill disputes between medical providers and health care payers. This rule injects more transparency and accountability into the process so patients are not caught in the middle between health insurers and providers. I want to thank Secretary Kennedy and Dr. Oz for working with Congress to bolster this critical patient protection.”
A report released in February by the Government Accountability Office found the No Surprises Act directly benefited patients by promoting more in-network care and fewer surprise bills. However, Biden-era rulemaking made the IDR process inefficient and ineffective, which ultimately harmed the patients the law is intended to help. Under the failed policies of the prior administration, completion of the IDR process took an average of 150 days, with the longest wait clocking in at 268 days. Medical providers and health insurers alike have expressed concern with the volume of ineligible claims and restrictive batching rules, which delay dispute resolutions. The Trump Administration final rule makes critical improvements to the failed status quo and lays the foundation to continuously build on patient protections and improve the payment dispute resolution process.
Key Points of New Trump Administration Rule:
The final rule takes important steps to bring long-awaited clarity and stability to the IDR process.
- Improved communication between payers and providers, such as a requirement for payers to communicate using standardized claim codes – a critical step to reduce the surge in ineligible claims.
- Creation of a payer registry so providers can easily identify the correct payer in a dispute.
- Reforms to the open negotiation period so payers and providers can efficiently settle disputes before entering the IDR process.
- New 5-business day limit for IDR entities (IDREs) to determine claim eligibility.
- Cut to administrative fees paid by providers filing IDR claims from $115 per claim to $15 per claim – an 85 percent reduction in cost.
- Doubles the threshold from 25 to 50 qualified IDR items and services that may be batched in a claim filed by a single provider against a single insurer – a significant change that will improve the speed with which the IDR process can make claim determinations.
Key Patient Protections in the No Surprises Act:
- Provides protections against surprise medical bills for patients in emergent situations or receiving care from out-of-network providers operating in in-network facilities.
- Establishes the framework for a fair and balanced IDR system to ensure adequate payments between health insurers and medical providers treating emergency care patients.
- Requires health insurers and medical providers to provide Advanced Explanation of Benefits (AEOBs) and good faith estimates of the expected costs for medical services before they are delivered.
- Improves transparency in payment and provider directories so patients are properly informed before receiving medical procedures.
Timeline of Ways and Means Committee Oversight of the No Surprises Act Implementation:
May 16, 2023 – Hearing on Health Care Price Transparency: A Patient’s Right to Know
September 19, 2023 – Hearing on Reduced Care for Patients: Fallout from Flawed Implementation of Surprise Medical Billing Protections
October 18, 2023 – Bipartisan roundtable with Biden Administration officials on the No Surprises Act
November 9, 2023 – Ways and Means Republican letter to Treasury, HHS, Labor reiterating support for implementation of the law as Congress intended
September 5, 2025 – Ways and Means Republicans letter to the Trump Administration urging federal rules that correctly implement the No Surprises Act on behalf of patients.
Background:
READ: Six Key Moments from Ways and Means Committee Hearing on Health Care Price Transparency
READ: Top Five Moments from Ways and Means Hearing on Flawed Implementation of the No Surprises Act
READ: Ways and Means Committee Holds Roundtable with Biden Admin Officials on Failed Implementation of Medical Surprise Billing Protections
READ: Ways and Means Republicans Demand Biden Administration Follow the Law to End Surprise Medical Billing