N-2023-04: Calculating the qualifying payment amounts in 2023

Notice 2023-04 provides the indexing factors to be used by group health plans and health insurance issuers to calculate the qualifying payment amount (QPA) for items or services provided on or after January 1, 2023, and before January 1, 2024. The No Surprises Act (NSA) added parallel provisions at Code sections 9816 and 9817, ERISA sections 716 and 717, and PHS Act sections 2799A-1 and 2799A-2. These provisions provide protections against balance-billing for certain out-of-network items or services provided to patients. 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. QPAs based on information from prior years are indexed based on changes in the consumer price index.

Notice 2023-04 will be in IRB: 2023-2, dated: January 09, 2023.

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