Departments Release FAQs on No Surprises Act: QPA Calculation and Gag Clause Attestation

The Internal Revenue Service (IRS) released Notice 2025-12 providing the percentage increase for calculating the qualifying payment amounts (QPAs) for items and services furnished during 2025. The QPA calculation is required in the case of a plan or issuer that does not have sufficient information to calculate the median of the contracted rates for the same or similar item or service provided in a geographic region. The plan or issuer must calculate the QPA by increasing the QPA amount determined for the item or service for the year immediately preceding the subsequent year, by the percentage increase in the U.S. city average consumer price index (CPI-U) over the preceding year.

The percentage increase in the CPI-U for items and services provided in 2025 over the preceding year is the average CPI-U for 2024 over the average CPI-U for 2023. Pursuant to this calculation, the percentage increase from 2024 to 2025 is 1.0317904930.  Plans and issuers may round any resulting QPAs to the nearest dollar.

IRS Notice 2025-12 is effective January 1, 2025.

The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury jointly prepared FAQs Part 69 about Consolidated Appropriations Act, 2021 implementation. The first set of FAQs are QPA calculations and disclosure process in light of the Fifth Circuit Court decision in Texas Medical Association III. Plans and issuers will have to calculate QPAs using a good faith, reasonable interpretation of the applicable statutes and regulations that remain in effect. The departments are extending enforcement discretion.

FAQs about the Gag Clause Prohibition and attestation requirements address down steam agreements, what is considered a restriction on access to de-identified data, and attestation when a plan is aware that an agreement violates the Gag Clause Prohibition.