Prescription Drug and Health Care Spending
- 2024 Report to Congress: Prescription Drug Spending, Pricing Trends, and Premiums in Private Health Insurance Plans
- 2024 Appendix: Prescription Drug Prices, Rebates, and Insurance Premiums
- RxDC reporting instructions for the 2023 reference year
- Information Collection submission for OMB review (2023 Reference Year)
- Proposed Updated Information Collection (2022 Reference Year)
- RxDC reporting instructions for the 2022 Reference Year
- FAQs Part 56
- HHS RxDC Webinar
- Updated 2023 Prescription Drug Data Collection (RxDC) FAQs
- Prescription Drug Data Collection (RxDC) FAQs
- RxDC Reporting Instructions for the 2020 and 2021 Reference Years
- RxDC templates and data dictionary
- RxDC drug name and therapeutic class crosswalk
- Interim Final Rule
- News Release
- HHS Fact Sheet
Requirements Related to Surprise Billing, Part II
- Federal Independent Dispute Resolution Public Use Files (cms.gov)
- No Surprises Act (NSA) Independent Dispute Resolution (IDR) Partial Reopening of Dispute Initiation Frequently Asked Questions (FAQs), October 6, 2023 (cms.gov)
- August 2023 IDR Administrative Fees FAQs
- Amendment to the Calendar Year 2023 Federal IDR Process Fee Guidance
- Initial Report on the Independent Dispute Resolution Process: April 15 – September 30, 2022
- Federal Independent Dispute Resolution Process – Status Update
- Partial Report on the Independent Dispute Resolution (IDR) Process: October 1 – December 31, 2022
- Calendar Year 2023 Federal IDR Process Fee Guidance
- Final Rule (Downcoding Disclosure and IDR Process)
- Affordable Care Act Implementation FAQs Part 55
- Fact Sheet
- Federal Independent Dispute Resolution Process Status Update
- News release
- Federal Independent Resolution Process Portal – The Federal Independent Dispute Resolution (IDR) system (Federal IDR Portal) is live and available to receive requests for resolution of payment disputes for certain out of network health care items and services. You can initiate a Federal IDR request here: https://nsa-idr.cms.gov/paymentdisputes/s/
- Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities -- This document provides guidance to certified IDR entities with an overview of the IDR process and their responsibilities as part of the process. You can access the guidance at: https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/federal-independent-dispute-resolution-process-guidance-for-certified-idr-entities.pdf
- For all items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022 https://www.cms.gov/files/document/federal-idr-guidance-idr-entities-march-2023.pdf
- Federal Independent Dispute Resolution (IDR) Process Guidance for Disputing Parties -- This document provides information on how the disputing parties engage in open negotiation prior to the Federal IDR Process, initiate the Federal IDR Process, select a certified IDR entity, and meet the requirements of the Federal IDR Process. You can access the guidance at: https://www.cms.gov/files/document/federal-independent-dispute-resolution-guidance-disputing-parties.pdf
- For all items and services furnished on or after October 25, 2022 for plan years beginning on or after January 1, 2022 : https://www.cms.gov/files/document/federal-idr-guidance-disputing-parties-march-2023.pdf
- Memorandum Regarding Continuing Surprise Billing Protections for Consumers
- Interim Final Rule with Request for Comments
- Petition Process for Certification of IDR Entities
- News Release
- Calendar Year 2022 Federal IDR Process Fee Guidance
- CMS External Review Guidance Regarding State Process
- Information collection documents associated with Federal independent dispute resolution process requirements
- Paperwork Reduction Act Supporting Statement for Federal Independent Dispute Resolution Process
- Open Negotiation Period Notice
- Notice of IDR Initiation
- Notice of IDR Entity Selection
- Notice of Agreement on an Out-of-Network Rate
- Notice of Offer
- IDR Certification Application
- Petition for Certification Denial or Revocation
- Monthly IDR Entity Reporting Requirements
- Request for Extension Due to Extenuating Circumstances
- Certified IDR Entity Written Determination
- Information collection documents associated with external review requirements
Federal Independent Dispute Resolution (IDR) Operations
Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee Ranges
No Surprises Act Implementation FAQs
- Affordable Care Act Implementation FAQs Part 69
- Affordable Care Act Implementation FAQs Part 67
- Affordable Care Act Implementation FAQs Part 63
- Affordable Care Act Implementation FAQs Part 62
- Affordable Care Act Implementation FAQs Part 60
- Affordable Care Act Implementation FAQs Part 49
Prohibition on Gag Clauses on Price and Quality Information in Provider Agreements
- 2024 Instructions
- 2024 User Manual
- 2024 Template
- FAQs Part 57
- Gag Clause Prohibition Compliance Attestation System
- 2023 Instructions
- 2023 User Manual
- 2023 Template
Advanced Explanation of Benefits
Provider Nondiscrimination
Group Health Plan Service Provider Disclosures Under ERISA Section 408(b)(2)(B)
Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement
Requirements Related to Surprise Billing, Part I
- Final Rule (Downcoding Disclosure and IDR Process)
- Fact Sheet
- News release
- Interim Final Rule with Request for Comments
- Model Notice
- HHS Guidance on Model Notice
- Fact Sheet for Consumers
- Fact Sheet for Group Health Plans and Health Insurance Issuers
- HHS News Release