Regulatory Updates
Regulatory Updates provide quick access to employee benefit regulations, rulings and other guidance released by governmental agencies in the U.S. and Canada.
New updates to this page may be included in Today’s Headlines which is emailed to International Foundation members each business day. Inquiries regarding these updates should be directed to the Benefits Knowledge Center at the International Foundation at (888) 334-3327, option 5 or [email protected].
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IRS Releases Calculation for the Qualifying Payment Amount in 2026
The Internal Revenue Service (IRS) released Notice 2025-65 providing the percentage increase for calculating the qualifying payment amounts (QPAs) for items and services subject to the surprise billing provisions of the No Surprises Act (NSA) furnished during 2026.
The indexing factors are used by group health plans and health insurance issuers to calculate the QPA for items or services provided on or after January 1, 2026, and before January 1, 2027. The QPA is the basis for determining individual cost sharing for items and services covered by the balance-billing protections in the NSA, under certain circumstances. The QPA for a given calendar year is based on information regarding median rates for certain items and services from prior years and is indexed based on changes in the consumer price index (CPI-U).
The QPA is also one of the factors considered by a certified independent dispute resolution (IDR) entity to determine which of two offers submitted by parties to a payment dispute in the Federal IDR process best represents the value of a qualified IDR item or service as the out-of-network rate.
The percentage increase in the CPI-U over a preceding year is calculated by dividing the average CPI-U for the preceding year by the average CPI-U for the year immediately prior to the preceding year. For this purpose, the average CPI-U for a year is the average of the monthly CPI-Us published by the Bureau of Labor Statistics (BLS) of the Department of Labor (DOL) for the 12-month period ending on August 31 of each year, rounded to 10 decimal places. The percentage increase in the CPI-U for items and services provided in 2026 over the preceding year is the average CPI-U for 2025 over the average CPI-U for 2024. Pursuant to this calculation, the percentage increase from 2025 to 2026 is 1.0265311701. Plans and issuers may round any resulting QPAs to the nearest dollar.
Rulings and procedures reported in the Internal Revenue Bulletin (IRB) do not have the force and effect of Treasury Department Regulations, but they may be used as precedents.
IRS Notice 2025-65 is effective January 1, 2026.