UPDATE: IDR PROCESS RESUMES FOR CERTAIN DISPUTES

Following the Texas court's ruling in favor of the Texas Medical Association to rescind several No Surprises Act (NSA) regulations related to the independent dispute resolution (IDR) process, the Centers for Medicare & Medicaid Services (CMS) has issued guidance directing certified IDR entities to proceed with eligibility determinations submitted on or before Aug, 3, 2023, effective Sep. 5, 2023. Disputing parties with eligibility determinations submitted on or before Aug. 3, 2023, may continue to engage in open negotiation and should respond to requests for information from a certified IDR entity. All other aspects of the Federal IDR process remain suspended.

The agency is reviewing the court's decision and will update directions for the IDR process in concordance with the court's order. MGMA Government Affairs will continue to monitor for this future guidance and provide updates to membership.

CMS ANNOUNCES NEW AHEAD MODEL

CMS announced the introduction of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. This new voluntary state total cost of care model is intended to improve population health, curb healthcare cost growth, and advance health equity. Participating states will receive support to increase investment in primary care, provide financial stability for hospitals, and support connection for beneficiaries to community resources.

The AHEAD model is scheduled to operate for eleven years starting in 2024, and CMS will issue awards of up to $12 million to support implementation for up to eight states. The first Notice of Funding Opportunity for states to apply will be released in late fall 2023. CMS will host a webinar on Sep. 18 from 3 p.m. – 4:30 p.m. ET.

NEW PRIORITY BILL TRACKER RESOURCE FOR MEMBERS

To assist members in their advocacy efforts, MGMA Government Affairs created a priority bill tracker resource outlining legislative efforts that have been introduced during the 118th Congress impacting medical groups. This pending federal legislation reflects several of MGMA’s key advocacy priorities. We need your support to get these bills passed into law. Please visit MGMA’s Contact Congress portal to send a letter to your legislators on these important issues.