No Surprises Act Implementation FAQ Part 73 Extends QPA Calculation Enforcement Discretion

The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) released Consolidated Appropriations Act (2021) Implementation FAQ Part 73 on calculating Qualifying Payment Amounts (QPAs) under the No Surprises Act. The purpose is extending the enforcement relief regarding the use of QPAs announced in previous FAQs for items and services furnished on or after February 1, 2026, and before October 1, 2026.

FAQs address implementation of the No Surprises Act as a result of the Fifth Circuit Court of Appeals' decision in Texas Medical Association et al. v. U.S. Department of Health and Human Services et al. (TMA III) to grant a rehearing en banc and vacate the Fifth Circuit's October 30, 2024, panel opinion. 

The Departments extend the exercise of enforcement discretion, originally provided in FAQs Part 62 and extended in FAQs Parts 67, 69, and 71, under the relevant No Surprises Act provisions for any plan or issuer, or party to a payment dispute in the federal independent dispute resolution process, that uses a QPA calculated in accordance with the 2021 methodology, for items and services furnished on or after February 1, 2026, and before October 1, 2026, the first day of the calendar month that begins after 6 months from the issuance of these FAQs. 

Once a final decision has been reached in TMA III, the Departments anticipate issuing further guidance on QPA calculations in light of the court’s ruling.