This morning, the Departments of Health and Human Services, Labor, and Treasury (“the Departments”) released the years-in-the-making IDR Operations final rule. This final rule addresses provisions that the Departments first proposed in the Fall of 2023.
Highlights of the finalized provisions include:
– RARCs/CARCs. As requested by EDPMA, health plans will now be required to use RARC/CARC codes in initial payment communications. While the provision will be effective immediately, the Departments lay out a guidance and enforcement timeline that will occur over approximately the next year.
– Health Plan IDR Registry. As requested by EDPMA, the Departments have finalized the creation of an IDR Registry that requires health plans to register their insurance products creating a directory of plans that will provide disputing parties with more information that could help inform federal IDR eligibility.
– Administrative Fee. As requested by EDPMA after demonstrating the Departments have more than sufficient funds to administer the IDR process, the Departments have agreed to lower the Administrative Fee for both parties to an IDR dispute. Beginning five days after the official publication of the final rule, the administrative fee will be lowered from $115 to $15.
To better facilitate negotiations prior to IDR initiation, the Departments are also creating and IDR Gateway as described by CMS “a centralized platform to manage disputes—launching in phases beginning in 2026. Users will be able to start disputes, track status, and manage activity in one place.”
EDPMA will continue to analyze the provisions of the final rule and provide more guidance and resources as it becomes available.
In the meantime, links to Department provided resources follow:
– IDR Operations Final Rule
– Department of Health and Human Services Press Release
– Centers for Medicare and Medicaid Services Fact Sheet