ACA Implementation FAQ Part 67 Extends QPA Calculation Enforcement Relief

Published May 02, 2024

The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the departments) have jointly prepared FAQs Part 67 extending enforcement relief regarding the use of qualified payment amount (QPA) calculations (announced in FAQs Part 62 on October 6, 2023).

FAQs address implementation of the No Surprises Act in light of the August 24, 2023, court decision in Texas Medical Association et al. v. U.S. Department of Health and Human Services et al. (TMA III) that provisions related to the methodology for calculating the QPA was unlawful. The case remains pending before the Fifth Circuit Court of Appeals.

The departments consider it appropriate to extend the enforcement relief because, since the issuance of FAQs Part 62, the departments have received feedback that, despite taking reasonable steps to come into compliance, plans and issuers need additional time to complete the significant efforts associated with recalculating QPAs in a manner consistent with the statutes and regulations that remain in effect after the TMA III vacatur, as several of the changes to the QPA calculation methodology necessitate a manual process to locate data.

For items and services furnished before November 1, 2024, the departments will exercise their enforcement discretion under the relevant No Surprises Act provisions for

Any plan or issuer, or party to a payment dispute in the Federal IDR process, that uses...
A provider, facility, or provider of air ambulance services that bills, or holds liable, a participant, beneficiary, or enrollee for a cost-sharing amount based on...

...a QPA calculated in accordance with the methodology under the July 2021 interim final rules and guidance in effect immediately before the decision in TMA III.

The departments expect this enforcement relief to expire October 31, 2024, and will continue to assess the status of QPA calculations.