U.S. Rep. Frank Pallone Jr., D-N.J., introduced legislation Oct. 8 that would eliminate the No Surprises Act’s arbitration process for most out-of-network payment disputes starting in 2028.
Mr. Pallone, one of the 2020 law’s original authors, said the bill, titled Lower Premiums, Faster Payments Act, is needed because a handful of bad actors, mostly backed by private equity, are exploiting arbitration. He said they are creating backlogs, delaying payments and driving up premiums. The bill would replace arbitration with a payment based on the median in-network rate.
Physician groups have opposed the bill, saying it would give insurers control over out-of-network payments and urged Congress to keep independent arbitration.
Here are five things to know about the bill:
1. It would ends arbitration for care delivered in 2028 and beyond.
The bill would eliminate the independent dispute resolution, or IDR, process for items and services furnished on or after Jan. 1, 2028. Claims for care delivered before that date could still go to arbitration. The No Surprises Act’s patient protections against surprise bills would remain.
2. The qualifying payment amount becomes the payment — and gets recalculated.
For 2028 and later, the out-of-network rate would be the qualifying payment amount, or QPA. Under current law, the QPA is one factor arbiters weigh; under the bill, it would be the final number.
The 2028 QPA would equal the median of a plan’s contracted rates as of Jan. 31, 2019, for the same or similar service, by a provider in the same specialty and region. It would count patient cost-sharing, the plan’s payment and the expected value of incentive or retroactive payments such as bonuses, risk-sharing payments and penalties.
Rates with providers that did not furnish the service in the 2019 plan year would be excluded. The figure would be raised by CPI-U inflation for 2019 through 2027, then by CPI-U each year after. Plans that did not exist in 2019 would start from a rate set under an HHS methodology.
3. Insurers would have 30 days to pay.
When the QPA is the out-of-network rate, plans would have to pay within 30 days after the provider or facility sends the bill. The requirement covers emergency services, nonemergency care from out-of-network clinicians at in-network facilities and air ambulance services.
4. The payment formula would be shielded from lawsuits, with more oversight.
The bill bars judicial review of the QPA methodology. Mr. Pallone’s office said court decisions weakened the law’s original payment guidelines and led to increasingly large arbitration awards.
HHS, the Labor Department and the Treasury would have 180 days after enactment to update the QPA rules and could use an interim final rule. Starting in 2028, they would also be required to audit claims data from at least 25 plans and insurers each year and make the findings public. Current law only says regulators “may” conduct those audits.
5. Pallone says a few private equity-backed groups are driving up costs.
According to committee Democrats, 10 provider groups submitted about 67% of the 2.5 million disputes filed in 2025. Fees tied to the arbitration process reached $1.3 billion last year, compared with $885 million across 2022 through 2024 combined, and the 15 certified arbitration firms awarded nearly $15 billion to providers.
Mr. Pallone said the arbitration process “is clearly not working.” Families USA backed the bill, with Executive Director Anthony Wright calling for Congress to close loopholes that let firms “secure inflated payments.”
As ranking member, Mr. Pallone will need support from the Republican majority to advance the bill. The release did not name any cosponsors.
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