No Surprises Act implementation in 2026: The regulatory “to-do” list | McDermott+

McDermott+ is happy to deliver you Regs & Eggs, a weekly Regulatory Affairs weblog by Jeffrey Davis.

January 15, 2026 – 2025 definitely was a busy 12 months within the regulatory world, with a slew of recent rules, fashions, and initiatives. Even so, the Trump administration nonetheless has a protracted regulatory (and deregulatory) “to-do” listing for 2026 – together with continued implementation of the No Surprises Act. The legislation, enacted in 2020 throughout President Trump’s first time period, tried to finish the follow of shock medical payments and steadiness billing by sure out-of-network suppliers. As said in a late 2024 Regs & Eggs blog postthere have been quite a few points and areas for potential motion that the incoming Trump administration might start to deal with in 2025. Nevertheless, with ongoing authorized challenges, proposed rules that haven’t been finalized, and complete provisions of the legislation which can be but to be applied, the administration had its palms full – and plenty of objects that began on the administration’s No Surprises Act “to-do” listing in 2025 are actually being carried over into 2026.

Listed here are a few of the main objects on the No Surprises Act regulatory “to-do” listing for 2026:

1. Finalize the impartial dispute decision (IDR) operations rule

The federal IDR course of gives a chance for a third-party arbitrator (known as an authorized IDR entity) to pick out fee quantities for sure out-of-network companies. If a supplier and well being plan can’t come to an settlement on a fee quantity for an eligible out-of-network service after exhausting a 30-day open negotiations interval, a supplier or well being plan (normally a supplier) can set off the IDR course of. Each events in a dispute (suppliers and well being plans) current affords to an authorized IDR entity, and the entity selects one of many affords utilizing elements prescribed within the No Surprises Act.

Because the IDR course of went into impact in 2022, stakeholders have reported a number of points. In an try to deal with these considerations, the US Departments of Well being and Human Providers (HHS), Labor, and Treasury below the Biden administration issued the IDR operations proposed rulewhich was printed within the Federal Register on November 3, 2023 (click here for our abstract). As with all proposed rule, the IDR operations rule had a public remark interval, and plenty of anticipated the ultimate rule to be issued in both 2024 or 2025. The primary unified agenda put out by the Trump administration focused November 2025 for launch of this ultimate rule. Nevertheless, work on the rule might have been impeded by the lengthy authorities shutdown, and November 2025 got here and went. The ultimate rule might now be issued early this 12 months. Even when the rule is launched throughout the subsequent few months, some insurance policies is probably not efficient for 90 and even 180 days after the rule is issued.

2. Launch advert hoc steering to enhance the IDR course of

The departments, particularly the Facilities for Medicare & Medicaid Providers (CMS) below HHS, have produced many resources on the IDR course of and are in common communication with collaborating stakeholders, together with IDR entities and disputing events. Nevertheless, some steering paperwork appear to have been in a holding sample in 2025 in gentle of ongoing litigation and the IDR operations rule nonetheless below growth. One notable steering doc CMS did launch in 2025 offered technical assistance for reopening closed disputes. This steering created a formalized course of for disputing events to ask CMS to have an authorized IDR entity reopen a dispute if a celebration believed the licensed IDR entity dedicated a selected sort of error through the IDR course of. CMS additionally launched revised frequently asked questions (FAQs) on the calculations of certified fee quantities (QPAs) and a few other updates on No Surprises Act implementation (together with a fact sheet that highlights the departments’ efforts to scale back the backlog of unresolved IDR disputes.)

As soon as the IDR operations ultimate rule is launched, we might see the departments concern extra subregulatory steering and FAQs to assist effectuate the rule’s insurance policies and tackle different notable points that stakeholders have recognized in areas similar to IDR eligibility, “batching” of comparable disputes, the 90-day “cooling off interval,” and enforcement of IDR necessities.

3. Proceed to launch knowledge and stories

CMS launched data and reports on the IDR course of throughout 2025 and can in all probability accomplish that on an analogous schedule in 2026. CMS publishes federal IDR public use information (PUFs) and federal IDR supplemental tables each six months, and overarching stories on the IDR course of each different month. The most recent PUFs embody complete knowledge on disputes from the fourth quarter of 2024, and the newest bimonthly knowledge report displays disputes obtained from October to November 2025. Traditionally, CMS has additionally launched enforcement reports and market conduct reviews that element compliance with No Surprises Act necessities.

4. Implement sections of the No Surprises Act that haven’t been absolutely applied

Many provisions within the No Surprises Act haven’t been absolutely applied but. In August 2021, the departments issued a guidance document stating that they didn’t plan to implement sure necessities by the statutory deadline of January 1, 2022. As said within the steering doc, these provisions included:

• Transparency in plan or insurance coverage identification playing cards. The legislation requires well being plans to “embody in clear writing, on any bodily or digital plan or insurance coverage identification card issued to contributors, beneficiaries, or enrollees, any relevant deductibles, any relevant out-of-pocket most limitations, and a phone quantity and web site tackle for people to hunt shopper help.”
• Superior clarification of advantages (AEOB). The legislation requires well being plans to ship enrollees an AEOB notification for sure companies that “contains: (1) the community standing of the supplier or facility; (2) the contracted charge for the service, or if the supplier or facility just isn’t a collaborating supplier or facility, an outline of how the person can acquire info on suppliers and amenities which can be collaborating; (3) a superb religion estimate obtained from the supplier; (4) a superb religion estimate of the quantity the plan or protection is chargeable for paying, and the quantity of any cost-sharing for which the person can be chargeable for paying with respect to the nice religion estimate obtained from the supplier; and (5) disclaimers indicating whether or not protection is topic to any medical administration methods.” (The departments applied the legislation’s good religion estimate requirement for people with out insurance coverage however haven’t applied the nice religion estimate and AEOB necessities for people with insurance coverage.)
• Enhancing the accuracy of supplier listing info. The legislation “established requirements associated to supplier directories which can be meant to guard enrollees below a plan or protection from shock billing. These provisions typically require plans to ascertain a course of to replace and confirm the accuracy of supplier listing info and to ascertain a protocol for responding to requests by phone and digital communication from a participant, beneficiary, or enrollee a couple of supplier’s community participation standing.”
• Continuity of care necessities. The legislation established “continuity of care protections that apply within the case of a person with advantages below a bunch well being plan or group or particular person medical health insurance protection supplied by a medical health insurance issuer.” These protections “guarantee continuity of care in cases when terminations of sure contractual relationships end in modifications in supplier or facility community standing.”

The departments have been making progress on these provisions, and we might see additional motion in 2026. With respect to the primary requirement, the departments included a proposal of their December 2025 transparency in coverage proposed rule that may require well being plans to make accessible to enrollees, at their request, cost-sharing estimates and different worth disclosures by way of a cellphone quantity. This cellphone quantity would should be the identical one that’s required to be discovered on the well being plan’s insurance coverage ID card below the No Surprises Act. The departments might finalize the proposal this 12 months, with a possible efficient date of January 1, 2027.

The departments even have offered updates on the implementation of the AEOB requirement, noting a few of the difficulties concerned in sharing good religion estimate info between suppliers and between suppliers and well being plans. The departments have been testing industry-wide requirements for knowledge sharing. Of their latest updatefrom December 2024, the departments famous that they’d use the data gathered from this testing to develop proposed necessities that “maximize the meaningfulness and value of AEOBs for shoppers.” The most recent unified agenda states that the departments plan to concern a proposed rule to implement the AEOB requirement in March 2026, however this timing might have been impacted by final 12 months’s extended authorities shutdown.

5. Handle enforcement discretion for QPA calculations

CMS launched FAQs on July 30, 2025, concerning enforcement of QPA calculations. Due to the continued Texas Medical Association (TMA) III lawsuitthe departments have been exercising enforcement discretion since October 2023 on how well being plans calculate the QPA. The departments have prolonged the interval of enforcement discretion six months at a time, permitting well being plans to depend on any QPAs which have already been calculated utilizing a superb religion, cheap interpretation of the present methodology.

Within the newest FAQs, the departments responded to the US Court docket of Appeals for the Fifth Circuit’s grant of in bench rehearing to the TMA III plaintiffs. Based mostly on that authorized growth, the departments determined to increase the interval of enforcement discretion for one more six months, till February 1, 2026. The departments said that “(o)nce the Fifth Circuit’s in bench choice in TMA III is launched, the Departments . . . will consider whether or not it’s crucial to supply further enforcement aid. The Departments . . . don’t presently anticipate any such further enforcement aid would prolong past August 1, 2026, the primary day of the calendar month that’s 12 months after the issuance of those FAQs, however will reassess the standing of QPA recalculations and supply further steering as applicable.” The departments subsequently will seemingly concern a revised set of FAQs in February 2026 and maybe revisit the August 1, 2026, enforcement discretion expiration date.

6. Challenge QPA audits

The No Surprises Act requires the departments to conduct audits of QPA calculations. Whereas just one audit has been launched to date (in 2024), we might see extra in 2026. The departments are additionally required to concern annual stories to Congress on the variety of well being plans which were audited.

The departments might transfer ahead with different audits, together with audits of licensed IDR entities to ensure they’re utilizing applicable and constant approaches to rendering fee choices.

We might be rigorously monitoring the No Surprises Act to-do listing to see which objects get crossed off in 2026 and which carry over into 2027 and future years.

Till subsequent week, that is Jeffrey saying, take pleasure in studying regs together with your eggs.

(View source.)