Internal Revenue Bulletin 2023-47 (PDF rendition): IRS Notices

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Bulletin No. 2023–47
November 20, 2023
HIGHLIGHTS
OF THIS ISSUE
These synopses are intended only as aids to the reader in
identifying the subject matter covered. They may not be
relied upon as authoritative interpretations.
ADMINISTRATIVE
Announcement 2023-32, page 1258.
The Office of Professional Responsibility (OPR) announces
recent disciplinary sanctions involving attorneys, certified
public accountants, enrolled agents, enrolled actuaries,
enrolled retirement plan agents, and appraisers. These indi-
viduals are subject to the regulations governing practice
before the Internal Revenue Service (IRS), which are set out in
Title 31, Code of Federal Regulations, Part 10, and which are
published in pamphlet form as Treasury Department Circular
No. 230. The regulations prescribe the duties and restric-
tions relating to such practice and prescribe the disciplinary
sanctions for violating the regulations.
EMPLOYEE PLANS
Notice 2023-75, page 1256.
Section 415 of the Internal Revenue Code (the Code) pro-
vides for dollar limitations on benefits and contributions
under qualified retirement plans. Section 415(d) requires
that the Secretary of the Treasury annually adjust these
limits for cost of living increases. Other limitations appli-
cable to deferred compensation plans are also affected
by these adjustments under § 415. Under § 415(d), the
adjustments are to be made under adjustment procedures
similar to those used to adjust benefit amounts under
§ 215(i)(2)(A) of the Social Security Act.
EXEMPT ORGANIZATIONS
Announcement 2023-33, page 1261.
Revocation of IRC 501(c)(3) Organizations for failure to meet
the code section requirements. Contributions made to the
organizations by individual donors are no longer deductible
under IRC 170(b)(1)(A).
EXCISE TAX
REG-115762-23, page 1262.
This document sets forth proposed rules related to the fees
established by the No Surprises Act for the Federal inde-
pendent dispute resolution (IDR) process, as established by
the Consolidated Appropriations Act, 2021 (CAA). These pro-
posed rules would amend existing regulations to provide that
the administrative fee amount charged by the Department of
the Treasury, the Department of Labor, and the Department
of Health and Human Services (the Departments) to partic-
ipate in the Federal IDR process, and the ranges for certi-
fied IDR entity fees for single and batched determinations
will be set by the Departments through notice and comment
rulemaking. These proposed rules would also set forth the
methodology used to calculate the administrative fee and
the considerations used to develop the certified IDR entity
fee ranges. This document also proposes the amount of the
administrative fee for disputes initiated on or after the later of
the effective date of these rules or January 1, 2024. Finally,
this document proposes the certified IDR entity fee ranges
for disputes initiated on or after the later of the effective date
of these rules or January 1, 2024.
REG-120727-21, page 1285.
This document extends the comment period for the proposed
rules entitled “Requirements Related to the Mental Health
Parity and Addiction Equity Act” that were published in the
August 3, 2023, issue of the Federal Register. The comment
period for the proposed rules, which had been scheduled to
close on October 2, 2023, is extended 15 days to October
17, 2023.
Finding Lists begin on page ii.

The IRS Mission
Provide America’s taxpayers top-quality service by helping
them understand and meet their tax responsibilities and
enforce the law with integrity and fairness to all.
Introduction
The Internal Revenue Bulletin is the authoritative instrument
of the Commissioner of Internal Revenue for announcing offi-
cial rulings and procedures of the Internal Revenue Service
and for publishing Treasury Decisions, Executive Orders, Tax
Conventions, legislation, court decisions, and other items of
general interest. It is published weekly.
It is the policy of the Service to publish in the Bulletin all sub-
stantive rulings necessary to promote a uniform application
of the tax laws, including all rulings that supersede, revoke,
modify, or amend any of those previously published in the
Bulletin. All published rulings apply retroactively unless other-
wise indicated. Procedures relating solely to matters of inter-
nal management are not published; however, statements of
internal practices and procedures that affect the rights and
duties of taxpayers are published.
Revenue rulings represent the conclusions of the Service
on the application of the law to the pivotal facts stated in
the revenue ruling. In those based on positions taken in rul-
ings to taxpayers or technical advice to Service field offices,
identifying details and information of a confidential nature are
deleted to prevent unwarranted invasions of privacy and to
comply with statutory requirements.
Rulings and procedures reported in the Bulletin do not have the
force and effect of Treasury Department Regulations, but they
may be used as precedents. Unpublished rulings will not be
relied on, used, or cited as precedents by Service personnel in
the disposition of other cases. In applying published rulings and
procedures, the effect of subsequent legislation, regulations,
court decisions, rulings, and procedures must be considered,
and Service personnel and others concerned are cautioned
against reaching the same conclusions in other cases unless
the facts and circumstances are substantially the same.
The Bulletin is divided into four parts as follows:
Part I.—1986 Code.
This part includes rulings and decisions based on provisions
of the Internal Revenue Code of 1986.
Part II.—Treaties and Tax Legislation.
This part is divided into two subparts as follows: Subpart A,
Tax Conventions and Other Related Items, and Subpart B,
Legislation and Related Committee Reports.
Part III.—Administrative, Procedural, and Miscellaneous.
To the extent practicable, pertinent cross references to these
subjects are contained in the other Parts and Subparts. Also
included in this part are Bank Secrecy Act Administrative
Rulings. Bank Secrecy Act Administrative Rulings are issued
by the Department of the Treasury’s Office of the Assistant
Secretary (Enforcement).
Part IV.—Items of General Interest.
This part includes notices of proposed rulemakings, disbar-
ment and suspension lists, and announcements.
The last Bulletin for each month includes a cumulative index
for the matters published during the preceding months. These
monthly indexes are cumulated on a semiannual basis, and are
published in the last Bulletin of each semiannual period.
November 20, 2023 Bulletin No. 2023–47
The contents of this publication are not copyrighted and may be reprinted freely. A citation of the Internal Revenue Bulletin as the source would be appropriate.

Part III
2024 Limitations Adjusted
as Provided in Section
415(d), etc.
Notice 2023-75
Section 415 of the Internal Revenue
Code (“Code”) provides for dollar limita-
tions on benefits and contributions under
qualified retirement plans. Section 415(d)
requires that the Secretary of the Treasury
annually adjust these limits for cost-of-liv-
ing increases. Other limitations applicable
to deferred compensation plans are also
affected by these adjustments under sec-
tion 415. Under section 415(d), the adjust-
ments are to be made under adjustment
procedures similar to those used to adjust
benefit amounts under section 215(i)(2)
(A) of the Social Security Act.
Cost-of-Living Adjusted Limits for
2024
Effective January 1, 2024, the limita-
tion on the annual benefit under a defined
benefit plan under section 415(b)(1)(A) of
the Code is increased from $265,000 to
$275,000.
For a participant who separated from
service before January 1, 2024, the par-
ticipant’s limitation under a defined ben-
efit plan under section 415(b)(1)(B) is
computed by multiplying the participant’s
compensation limitation, as adjusted
through 2023, by 1.0351.
The limitation for defined contribu-
tion plans under section 415(c)(1)(A) is
increased in 2024 from $66,000 to $69,000.
The Code provides that various other
dollar amounts are to be adjusted at the
same time and in the same manner as the
dollar limitation of section 415(b)(1)(A).
After taking into account the applicable
rounding rules, the amounts for 2024 are
as follows:
The limitation under section 402(g)
(1) on the exclusion for elective defer-
rals described in section 402(g)(3) is
increased from $22,500 to $23,000.
The annual compensation limit under
sections 401(a)(17), 404(l), 408(k)(3)
(C), and 408(k)(6)(D)(ii) is increased
from $330,000 to $345,000.
The dollar limitation under section
416(i)(1)(A)(i) concerning the defini-
tion of “key employee” in a top-heavy
plan is increased from $215,000 to
$220,000.
The dollar amount under section 409(o)
(1)(C)(ii) for determining the maxi-
mum account balance in an employee
stock ownership plan subject to a
5-year distribution period is increased
from $1,330,000 to $1,380,000, while
the dollar amount used to determine
the lengthening of the 5-year distribu-
tion period is increased from $265,000
to $275,000.
The limitation used in the definition of
“highly compensated employee” under
section 414(q)(1)(B) is increased from
$150,000 to $155,000.
The dollar limitation under section
414(v)(2)(B)(i) for catch-up contribu-
tions to an applicable employer plan
other than a plan described in sec-
tion 401(k)(11) or section 408(p) for
individuals aged 50 or over remains
$7,500. The dollar limitation under sec-
tion 414(v)(2)(B)(ii) for catch-up con-
tributions to an applicable employer
plan described in section 401(k)(11) or
section 408(p) for individuals aged 50
or over remains $3,500.
The annual compensation limitation
under section 401(a)(17) for eligible
participants in certain governmental
plans that, under the plan as in effect
on July 1, 1993, allowed cost-of-liv-
ing adjustments to the compensation
limitation under the plan under section
401(a)(17) to be taken into account, is
increased from $490,000 to $505,000.
The compensation amount under sec-
tion 408(k)(2)(C) regarding simplified
employee pensions remains $750.
The limitation under section 408(p)
(2)(E) regarding SIMPLE retirement
accounts is increased from $15,500 to
$16,000.
The limitation on the aggregate amount
of length of service awards accruing
with respect to any year of service
for any bona fide volunteer under
section 457(e)(11)(B)(ii) concerning
deferred compensation plans of state
and local governments and tax-exempt
organizations is increased from $7,000
to $7,500.
The limitation on deferrals under sec-
tion 457(e)(15) concerning deferred
compensation plans of state and local
governments and tax-exempt organi-
zations is increased from $22,500 to
$23,000.
The limitation under section 664(g)
(7) concerning the qualified gratuitous
transfer of qualified employer securi-
ties to an employee stock ownership
plan remains $60,000.
The compensation amount under §
1.61-21(f)(5)(i) of the Income Tax
Regulations concerning the definition
of “control employee” for fringe ben-
efit valuation purposes is increased
from $130,000 to $135,000. The com-
pensation amount under § 1.61-21(f)
(5)(iii) is increased from $265,000 to
$275,000.
The dollar limitation on premiums paid
for a qualifying longevity annuity con-
tract under § 1.401(a)(9)-6, A-17(b)(2)
(i), which was increased to $200,000
pursuant to section 202 of the SECURE
2.0 Act of 2022 (“SECURE 2.0 Act”
1
)
with respect to contracts purchased or
received in an exchange on or after
December 29, 2022 remains $200,000.
The Code provides that the
$1,000,000,000 threshold used to deter-
mine whether a multiemployer plan is a
systemically important plan under sec-
tion 432(e)(9)(H)(v)(III)(aa) of the Code
is adjusted using the cost-of-living adjust-
ment provided under section 432(e)(9)(H)
(v)(III)(bb). After taking the applicable
rounding rule into account, the threshold
1
Division T of the Consolidated Appropriations Act, 2023, Pub. L. 117-328, 136 Stat. 4459 (2022).
November 20, 2023 1256 Bulletin No. 2023–47

used to determine whether a multiem-
ployer plan is a systemically important
plan under section 432(e)(9)(H)(v)(III)
(aa) is increased from $1,256,000,000 to
$1,369,000,000.
The Code also provides that several
retirement-related amounts are to be
adjusted using the cost-of-living adjust-
ment under section 1(f)(3). After taking
the applicable rounding rules into account,
the amounts for 2024 are as follows:
The adjusted gross income limitation
under section 25B(b)(1)(A) for deter-
mining the retirement savings contri-
butions credit for married taxpayers
filing a joint return is increased from
$43,500 to $46,000; the limitation
under section 25B(b)(1)(B) is increased
from $47,500 to $50,000; and the lim-
itation under sections 25B(b)(1)(C)
and 25B(b)(1)(D) is increased from
$73,000 to $76,500.
The adjusted gross income limitation
under section 25B(b)(1)(A) for deter-
mining the retirement savings contri-
butions credit for taxpayers filing as
head of household is increased from
$32,625 to $34,500; the limitation
under section 25B(b)(1)(B) is increased
from $35,625 to $37,500; and the lim-
itation under sections 25B(b)(1)(C)
and 25B(b)(1)(D) is increased from
$54,750 to $57,375.
The adjusted gross income limitation
under section 25B(b)(1)(A) for deter-
mining the retirement savings contri-
butions credit for all other taxpayers
is increased from $21,750 to $23,000;
the limitation under section 25B(b)
(1)(B) is increased from $23,750 to
$25,000; and the limitation under sec-
tions 25B(b)(1)(C) and 25B(b)(1)(D) is
increased from $36,500 to $38,250.
The deductible amount under sec-
tion 219(b)(5)(A), which limits the
amount of an individual’s deductible
qualified retirement contributions for a
taxable year, is increased from $6,500
to $7,000. The increase in the deduct-
ible amount pursuant to section 219(b)
(5)(B)(ii) for individuals who have
attained age 50 before the close of the
taxable year remains $1,000.
The applicable dollar amount under
section 219(g)(3)(B)(i) for determining
the deductible amount of an IRA con-
tribution for taxpayers who are active
participants filing a joint return or as a
qualifying widow(er) is increased from
$116,000 to $123,000. The applicable
dollar amount under section 219(g)(3)
(B)(ii) for all other taxpayers who are
active participants (other than married
taxpayers filing separate returns) is
increased from $73,000 to $77,000. If
an individual or the individual’s spouse
is an active participant, the applicable
dollar amount under section 219(g)
(3)(B)(iii) for a married individual fil-
ing a separate return is not subject to
an annual cost-of-living adjustment
and remains $0. The applicable dollar
amount under section 219(g)(7)(A) for
a taxpayer who is not an active partici-
pant but whose spouse is an active par-
ticipant is increased from $218,000 to
$230,000.
Accordingly, under section 219(g)(2)
(A), the deduction for taxpayers mak-
ing contributions to a traditional IRA
is phased out for single individuals and
heads of household who are active par-
ticipants in a qualified plan (or another
retirement plan specified in section
219(g)(5)) and have adjusted gross
incomes (as defined in section 219(g)
(3)(A)) between $77,000 and $87,000,
increased from between $73,000 and
$83,000. For married couples filing
jointly, if the spouse who makes the IRA
contribution is an active participant,
the income phase-out range is between
$123,000 and $143,000, increased from
between $116,000 and $136,000. For
an IRA contributor who is not an active
participant and is married to someone
who is an active participant, the deduc-
tion is phased out if the couple’s income
is between $230,000 and $240,000,
increased from between $218,000 and
$228,000. For a married individual fil-
ing a separate return who is an active
participant, the phase-out range is not
subject to an annual cost-of-living
adjustment and remains $0 to $10,000.
The adjusted gross income limitation
under section 408A(c)(3)(B)(ii)(I)
for determining the maximum Roth
IRA contribution for married taxpay-
ers filing a joint return or for taxpay-
ers filing as a qualifying widow(er) is
increased from $218,000 to $230,000.
The adjusted gross income limitation
under section 408A(c)(3)(B)(ii)(II) for
all other taxpayers (other than married
taxpayers filing separate returns) is
increased from $138,000 to $146,000.
The applicable dollar amount under
section 408A(c)(3)(B)(ii)(III) for a
married individual filing a separate
return is not subject to an annual cost-
of-living adjustment and remains $0.
Accordingly, under section 408A(c)(3)
(A), the adjusted gross income phase-
out range for taxpayers making con-
tributions to a Roth IRA is between
$230,000 and $240,000 for married
couples filing jointly, increased from
between $218,000 and $228,000. For
singles and heads of household, the
income phase-out range is between
$146,000 and $161,000, increased
from between $138,000 and $153,000.
For a married individual filing a sep-
arate return, the phase-out range is
not subject to an annual cost-of-living
adjustment and remains between $0
and $10,000.
The aggregate amount of qualified
charitable distributions that are not
includible in gross income under sec-
tion 408(d)(8)(A) is increased from
$100,000 to $105,000. The amount of
qualified charitable distributions made
directly to a split-interest entity that are
not includible in gross income under
section 408(d)(8)(F) pursuant to a one-
time election is increased from $50,000
to $53,000.
Drafting Information
The principal author of this notice is
Tom Morgan of the Office of Associate
Chief Counsel (Employee Benefits,
Exempt Organizations, and Employment
Taxes). However, other personnel from
the IRS participated in the development
of this guidance. For further information
regarding this notice, contact Mr. Morgan
at (202) 317-6700 (not a toll-free number).
Bulletin No. 2023–47 1257 November 20, 2023

November 20, 2023 1258 Bulletin No. 2023–47
Part IV
Announcement of
Disciplinary Sanctions
From the Office of
Professional Responsibility
Announcement 2023-32
The Office of Professional
Responsibility (OPR) announces recent
disciplinary sanctions involving attor-
neys, certified public accountants,
enrolled agents, enrolled actuaries,
enrolled retirement plan agents, apprais-
ers, and unenrolled/unlicensed return
preparers (individuals who are not
enrolled to practice and are not licensed
as attorneys or certified public accoun-
tants). Licensed or enrolled practitioners
are subject to the regulations govern-
ing practice before the Internal Revenue
Service (IRS), which are set out in Title
31, Code of Federal Regulations, Subtitle
A, Part 10, and which are released as
Treasury Department Circular No. 230.
The regulations prescribe the duties and
restrictions relating to such practice and
prescribe the disciplinary sanctions for
violating the regulations. Unenrolled/
unlicensed return preparers are subject
to Revenue Procedure 81-38 and super-
seding guidance in Revenue Procedure
2014-42, which govern a preparer’s eli-
gibility to represent taxpayers before the
IRS in examinations of tax returns the
preparer both prepared for the taxpayer
and signed as the preparer. Additionally,
unenrolled/unlicensed return preparers
who voluntarily participate in the Annual
Filing Season Program under Revenue
Procedure 2014-42 agree to be subject to
the duties and restrictions in Circular 230,
including the restrictions on incompetent
or disreputable conduct.
The disciplinary sanctions to be
imposed for violation of the applicable
standards are:
Disbarred from practice before the
IRS—An individual who is disbarred
is not eligible to practice before the IRS
as defined at 31 C.F.R. § 10.2(a)(4) for a
minimum period of five (5) years.
Suspended from practice before the
IRS—An individual who is suspended is
not eligible to practice before the IRS as
defined at 31 C.F.R. § 10.2(a)(4) during
the term of the suspension.
Censured in practice before the
IRS—Censure is a public reprimand.
Unlike disbarment or suspension, censure
does not affect an individual’s eligibility
to practice before the IRS, but OPR may
subject the individual’s future practice
rights to conditions designed to promote
high standards of conduct.
Monetary penalty—A monetary pen-
alty may be imposed on an individual who
engages in conduct subject to sanction,
or on an employer, firm, or entity if the
individual was acting on its behalf and it
knew, or reasonably should have known,
of the individual’s conduct.
Disqualification of appraiser—An
appraiser who is disqualified is barred
from presenting evidence or testimony in
any administrative proceeding before the
Department of the Treasury or the IRS.
Ineligible for limited practice—An
unenrolled/unlicensed return preparer
who fails to comply with the requirements
in Revenue Procedure 81-38 or to comply
with Circular 230 as required by Revenue
Procedure 2014-42 may be determined
ineligible to engage in limited practice as
a representative of any taxpayer.
Under the regulations, individuals
subject to Circular 230 may not assist, or
accept assistance from, individuals who
are suspended or disbarred with respect
to matters constituting practice (i.e., rep-
resentation) before the IRS, and they may
not aid or abet suspended or disbarred
individuals to practice before the IRS.
Disciplinary sanctions are described in
these terms:
Disbarred by decision, Suspended
by decision, Censured by decision,
Monetary penalty imposed by decision,
and Disqualified after hearing—An
administrative law judge (ALJ) issued a
decision imposing one of these sanctions
after the ALJ either (1) granted the gov-
ernment’s summary judgment motion or
(2) conducted an evidentiary hearing upon
OPR’s complaint alleging violation of the
regulations. After 30 days from the issu-
ance of the decision, in the absence of an
appeal, the ALJ’s decision becomes the
final agency decision.
Disbarred by default decision,
Suspended by default decision,
Censured by default decision, Monetary
penalty imposed by default decision,
and Disqualified by default decision—
An ALJ, after finding that no answer to
OPR’s complaint was filed, granted OPR’s
motion for a default judgment and issued a
decision imposing one of these sanctions.
Disbarment by decision on appeal,
Suspended by decision on appeal,
Censured by decision on appeal,
Monetary penalty imposed by decision
on appeal, and Disqualified by decision
on appeal—The decision of the ALJ was
appealed to the agency appeal authority,
acting as the delegate of the Secretary
of the Treasury, and the appeal authority
issued a decision imposing one of these
sanctions.
Disbarred by consent, Suspended
by consent, Censured by consent,
Monetary penalty imposed by consent,
and Disqualified by consent—In lieu of
a disciplinary proceeding being instituted
or continued, an individual offered a con-
sent to one of these sanctions and OPR
accepted the offer. Typically, an offer of
consent will provide for: suspension for
an indefinite term; conditions that the
individual must observe during the sus-
pension; and the individual’s opportu-
nity, after a stated number of months, to
file with OPR a petition for reinstatement
affirming compliance with the terms of
the consent and affirming current fitness
and eligibility to practice (i.e., an active
professional license or active enrollment
status, with no intervening violations of
the regulations).
Suspended indefinitely by decision in
expedited proceeding, Suspended indef-
initely by default decision in expedited
proceeding, Suspended by consent in
expedited proceeding—OPR instituted
an expedited proceeding for suspension
(based on certain limited grounds, includ-
ing loss of a professional license for cause,
and criminal convictions).

Bulletin No. 2023–47 1259 November 20, 2023
Determined ineligible for limited
practice---There has been a final deter-
mination that an unenrolled/unlicensed
return preparer is not eligible for limited
representation of any taxpayer because the
preparer violated standards of conduct or
failed to comply with any of the require-
ments to act as a representative.
A practitioner who has been disbarred
or suspended under 31 C.F.R. § 10.60, or
suspended under § 10.82, or a disqualified
appraiser may petition for reinstatement
before the IRS after the expiration of 5
years following such disbarment, suspen-
sion, or disqualification (or immediately
following the expiration of the suspension
or disqualification period if shorter than 5
years). Reinstatement will not be granted
unless the IRS is satisfied that the peti-
tioner is not likely to engage thereafter in
conduct contrary to Circular 230, and that
granting such reinstatement would not be
contrary to the public interest.
Reinstatement decisions are published
at the individual’s request, and described
in these terms:
Reinstated to practice before the
IRS---The individual’s petition for
reinstatement has been granted. The
agent, and eligible to practice before the
IRS, or in the case of an appraiser, the
individual is no longer disqualified.
Reinstated to engage in limited
practice before the IRS---The individ-
ual’s petition for reinstatement has been
granted. The individual is an unenrolled/
unlicensed return preparer and eligible to
engage in limited practice before the IRS,
subject to requirements the IRS has pre-
scribed for limited practice by tax return
preparers.
OPR has authority to disclose the
grounds for disciplinary sanctions in these
situations: (1) an ALJ or the Secretary’s
delegate on appeal has issued a final
decision; (2) the individual has settled a
disciplinary case by signing OPR’s “con-
sent to sanction” agreement admitting to
one or more violations of the regulations
and consenting to the disclosure of the
admitted violations (for example, failure
to file Federal income tax returns, lack of
due diligence, conflict of interest, etc.); (3)
OPR has issued a decision in an expedited
proceeding for indefinite suspension; or
(4) OPR has made a final determination
(including any decision on appeal) that an
unenrolled/unlicensed return preparer is
ineligible to represent any taxpayer before
the IRS.
Announcements of disciplinary sanc-
tions appear in the Internal Revenue
Bulletin at the earliest practicable date.
The sanctions announced below are alpha-
betized first by state and second by the last
names of the sanctioned individuals.
City & StateNameProfessional
Designation
Disciplinary SanctionEffective Date(s)
Alabama
BirminghamStewart, Jr., Otis J.Attorney/CPASuspended by ALJ DecisionIndefinite from
May 21, 2023
California
Buena ParkPak, James J.Attorney/CPAReinstated to practice
before the IRS, effective
09/28/2023
Colorado
Highlands RanchParsons, Robert L.CPASuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023
Georgia
CovingtonMurray, Walter V.CPASuspended by decision in
expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023
Kentucky
LouisvilleBrauckmann, John A.CPASuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023
Maine
Carabaset ValleyDardis, Edward G.AttorneySuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 11, 2023

November 20, 2023 1260 Bulletin No. 2023–47
City & StateNameProfessional
Designation
Disciplinary SanctionEffective Date(s)
Minneapolis
Saint PaulShah, Ronak R.CPASuspended by decision in
expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
September 28, 2023
Mississippi
JacksonSeawright, John D.AttorneySuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
September 28, 2023
New York
Thornwood Vigna, Anthony P.AttorneySuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023
White PlainsSavignano, John J.CPASuspended by consent for
admitted violations of
31 C.F.R § 10.51(a)(2)
Indefinite from
July 06, 2023
North Carolina
Charlotte Sharper, Sr.,
Anthony M.
CPASuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023
HamletGarner, Jonathan B.AttorneySuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
September 28, 2023
South Carolina
Sharper, Sr.,
Anthony M., see North
Carolina
Tennessee
Knoxville Gee, Jr., Edgar H.CPAReinstated to practice
before the IRS, effective
July 25, 2023
Texas
Georgetown Corn, Pamela L.CPASuspended by decision in
expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023
Red OakHeckathorn, Milton Ben
(aka Ben Heckathorn)
Attorney/CPASuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
September 28, 2023
Wisconsin
Wisconsin RapidsCanfield, James L.Enrolled AgentSuspended by default decision
in expedited proceeding under
31 C.F.R. § 10.82(b)
Indefinite from
July 25, 2023

Bulletin No. 2023–47 1261 November 20, 2023
Deletions From Cumulative
List of Organizations,
Contributions to Which are
Deductible Under Section
170 of the Code
Announcement 2023-33
The Internal Revenue Service has
revoked its determination that the organi-
zations listed below qualify as organiza-
tions described in sections 501(c)(3) and
170(c)(2) of the Internal Revenue Code of
1986.
Generally, the IRS will not disallow
deductions for contributions made to a
listed organization on or before the date
of announcement in the Internal Revenue
Bulletin that an organization no longer
qualifies. However, the IRS is not pre-
cluded from disallowing a deduction for
any contributions made after an organiza-
tion ceases to qualify under section 170(c)
(2) if the organization has not timely filed
a suit for declaratory judgment under sec-
tion 7428 and if the contributor (1) had
knowledge of the revocation of the ruling
or determination letter, (2) was aware that
such revocation was imminent, or (3) was
in part responsible for or was aware of the
activities or omissions of the organization
that brought about this revocation.
If on the other hand a suit for declar-
atory judgment has been timely filed,
contributions from individuals and orga-
nizations described in section 170(c)(2)
that are otherwise allowable will continue
to be deductible. Protection under sec-
tion 7428(c) would begin on November
20, 2023 and would end on the date the
court first determines the organization is
not described in section 170(c)(2) as more
particularly set for in section 7428(c)(1).
For individual contributors, the maximum
deduction protected is $1,000, with a hus-
band and wife treated as one contributor.
This benefit is not extended to any indi-
vidual, in whole or in part, for the acts or
omissions of the organization that were
the basis for revocation.
NAME OF ORGANIZATION
Effective Date of
Revocation
LOCATION
GUATEMALA INSTITUTE FOR BIBICAL EVENGELISM INC.01/01/2020BELTON, TX
CAMBRIDGEPORT TEACHER ORGANIZATION INC07/01/2020CAMBRIDGE, MA
HARMON COUNTY HEALTHCARE AUTHORITY03/01/2019HOLLIS, OK
DOGS DAYS RANCH AND RESCUE01/01/2021WINONA, TX

November 20, 2023 1262 Bulletin No. 2023–47
Notice of Proposed
Rulemaking
Federal Independent
Dispute Resolution (IDR)
Process Administrative Fee
and Certified IDR Entity Fee
Ranges
REG 115762-23
DEPARTMENT OF THE
TREASURY
Internal Revenue Service
26 CFR Part 54
DEPARTMENT OF LABOR
Employee Benefits Security
Administration
29 CFR Part 2590
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Centers for Medicare &
Medicaid Services
45 CFR Part 149
AGENCY: Internal Revenue Service,
Department of the Treasury; Employee
Benefits Security Administration,
Department of Labor; Centers for Medicare
& Medicaid Services, Department of
Health and Human Services.
ACTION: Proposed rules.
SUMMARY: This document sets forth
proposed rules related to the fees estab-
lished by the No Surprises Act for the
Federal independent dispute resolution
(IDR) process, as established by the
Consolidated Appropriations Act, 2021
(CAA). These proposed rules would
amend existing regulations to pro-
vide that the administrative fee amount
charged by the Department of the
Treasury, the Department of Labor, and
the Department of Health and Human
Services (the Departments) to partic-
ipate in the Federal IDR process, and
the ranges for certified IDR entity fees
for single and batched determinations
will be set by the Departments through
notice and comment rulemaking. These
proposed rules would also set forth the
methodology used to calculate the admin-
istrative fee and the considerations used
to develop the certified IDR entity fee
ranges. This document also proposes the
amount of the administrative fee for dis-
putes initiated on or after the later of the
effective date of these rules or January
1, 2024. Finally, this document proposes
the certified IDR entity fee ranges for dis-
putes initiated on or after the later of the
effective date of these rules or January 1,
2024. In accordance with 5 U.S.C. 553(b)
(4), a summary of this rule may be found
at https://www.regulations.gov/.
DATES: To be assured consideration,
comments must be received at one of the
addresses provided below by October 26,
2023.
ADDRESSES: Written comments may
be submitted to the addresses specified
below. Any comment that is submitted
will be shared among the Departments.
Please do not submit duplicates.
Comments will be made available
to the public. Warning: Do not include
any personally identifiable information
(such as name, address, or other contact
information) or confidential business
information that you do not want pub-
licly disclosed. Comments are posted
on the internet exactly as received
and can be retrieved by most internet
search engines. No deletions, modifica-
tions, or redactions will be made to the
comments received, as they are public
records. Comments may be submitted
anonymously.
In commenting, refer to file code CMS-
9890-P. Because of staff and resource
limitations, the Departments cannot
accept comments by facsimile (FAX)
transmission.
Comments, including mass comment
submissions, must be submitted in one of
the following three ways (please choose
only one of the ways listed):
1. Electronically. You may submit
electronic comments on this regulation to
https://www.regulations.gov. Follow the
“Submit a comment” instructions.
2. By regular mail. You may mail writ-
ten comments to the following address
ONLY:
Centers for Medicare & Medicaid
Services,
Department of Health and Human
Services,
Attention: CMS-9890-P,
P.O. Box 8016,
Baltimore, MD 21244-8016.
Please allow sufficient time for mailed
comments to be received before the close
of the comment period.
3. By express or overnight mail. You
may send written comments to the follow-
ing address ONLY:
Centers for Medicare & Medicaid
Services,
Department of Health and Human
Services,
Attention: CMS-9890-P,
Mail Stop C4-26-05,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
For information on viewing pub-
lic comments, see the beginning of the
“SUPPLEMENTARY INFORMATION”
section.
FOR FURTHER INFORMATION
CONTACT: Shira B. McKinlay,
Internal Revenue Service, Department
of the Treasury, 202-317-5500; Shannon
Hysjulien or Rebecca Miller, Employee
Benefits Security Administration,
Department of Labor, 202-693-8335;
and Jacquelyn Rudich or Nora Simmons,
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, 301-492-5211.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments:
Comments received before the close of
the comment period will be available
for viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. The Departments will post
comments on the following website as
soon as possible after they have been
received: https://www.regulations.gov.
Follow the search instructions on that
website to view public comments. The

Bulletin No. 2023–47 1263 November 20, 2023
Departments will not post on Regulations.
gov public comments that make threats to
individuals or institutions or suggest that
the commenter will take actions to harm
an individual. The Departments continue
to encourage individuals not to submit
duplicative comments. The Departments
will post acceptable comments from mul-
tiple unique commenters even if the con-
tent is identical or nearly identical to other
comments.
I. Background
A. Preventing Surprise Medical Bills and
Establishing the Federal IDR Process
under the Consolidated Appropriations
Act, 2021
On December 27, 2020, the CAA was
enacted.
1
Title I, also known as the No
Surprises Act, and title II (Transparency)
of Division BB of the CAA amended
chapter 100 of the Internal Revenue Code
(Code), Part 7 of the Employee Retirement
Income Security Act (ERISA), and title
XXVII of the Public Health Service Act
(PHS Act). The No Surprises Act pro-
vides Federal protections against surprise
billing by limiting out-of-network cost
sharing and prohibiting balance billing
in many of the circumstances in which
surprise bills most frequently arise. In
particular, the No Surprises Act added
new provisions applicable to group health
plans and health insurance issuers offer-
ing group or individual health insurance
coverage. Section 102 of the No Surprises
Act added section 9816 of the Code,
2
sec-
tion 716 of ERISA,
3
and section 2799A-1
of the PHS Act,
4
which contain limita-
tions on cost sharing and requirements
regarding the timing of initial payments
and notices of denial of payment by
plans and issuers for emergency services
furnished by nonparticipating providers
and nonparticipating emergency facili-
ties, and for non-emergency services fur-
nished by nonparticipating providers for
patient visits to participating health care
facilities, generally defined as hospitals,
hospital outpatient departments, critical
access hospitals, and ambulatory surgical
centers.
5
Section 103 of the No Surprises Act
established a Federal IDR process that
plans and issuers and nonparticipating pro-
viders and facilities may utilize to resolve
certain disputes regarding out-of-network
rates under section 9816 of the Code,
6
sec-
tion 716 of ERISA,
7
and section 2799A-1
of the PHS Act.
8
Section 9816(c)(8) of the
Code,
9
section 716(c)(8) of ERISA,
10
and
section 2799A-1(c)(8) of the PHS Act
11

provide that each party to a determination
under the Federal IDR process shall pay
a fee for participating in the Federal IDR
process, and the amount of the fee is an
amount established by the Departments in
a manner such that the total amount of fees
paid by all parties is estimated to be equal
to the amount of expenditures estimated to
be made by the Departments for the year in
carrying out the Federal IDR process.
Section 105 of the No Surprises Act
added section 9817 of the Code,
12
section
717 of ERISA,
13
and section 2799A-2
of the PHS Act.
14
These sections contain
limitations on cost sharing and require-
ments for the timing of initial payments
and notices of denial of payment by plans
and issuers for air ambulance services fur-
nished by nonparticipating providers of
air ambulance services, and allow plans
and issuers and nonparticipating provid-
ers of air ambulance services to utilize the
Federal IDR process.
The No Surprises Act also added pro-
visions to title XXVII of the PHS Act in
a new part E
15
that apply to health care
providers, facilities, and providers of
air ambulance services, such as prohibi-
tions on balance billing for certain items
and services and requirements related
to disclosures about balance billing
protections.
The Departments of the Treasury,
Labor, and Health and Human Services
(HHS) (the Departments), along with the
Office of Personnel Management (OPM),
have issued rulemakings in 2021 and 2022
to implement various provisions of the No
Surprises Act. More specifically relevant to
this proposed rulemaking, the Departments
and OPM issued interim final rules (July
2021 interim final rules
16
and October
2021 interim final rules
17
) and final rules
(August 2022 final rules
18
) implementing
provisions of sections 9816 and 9817 of the
Code,
19
sections 716 and 717 of ERISA,
20

and sections 2799A-1 and 2799A-2 of
1
Pub. L. 116-260 (Dec. 27, 2020).
2
26 U.S.C. 9816, et seq.
3
29 U.S.C. 1185e, et seq.
4
42 U.S.C. 300gg–111, et seq.
5
Section 102(d)(1) of the No Surprises Act amended the Federal Employees Health Benefits Act, 5 U.S.C. 8901 et seq., by adding a new subsection (p) to 5 U.S.C. 8902. Under this new
provision, each FEHB Program contract must require a carrier to comply with requirements described in sections 9816 and 9817 of the Code, sections 716 and 717 of ERISA, and sections
2799A-1 and 2799A-2 of the PHS Act (as applicable) in the same manner as these provisions apply with respect to a group health plan or health insurance issuer offering group or individual
health insurance coverage.
6
26 U.S.C. 9816, et seq.
7
29 U.S.C. 1185e, et seq.
8
42 U.S.C. 300gg–111, et seq.
9
26 U.S.C. 9816(c)(8).
10
29 U.S.C. 1185e(c)(8).
11
42 U.S.C. 300gg–111(c)(8).
12
26 U.S.C. 9817, et seq.
13
29 U.S.C. 1185f, et seq.
14
42 U.S.C. 300gg–112, et seq.
15
42 U.S.C. 300gg-131-139.
16
86 FR 36872 (July 13, 2021).
17
86 FR 55980 (October 7, 2021).
18
87 FR 52618 (August 26, 2022).
19
26 U.S.C. 9816, et seq. and 26 U.S.C. 9817, et seq.
20
29 U.S.C. 1185e, et seq. and 29 U.S.C. 1185f, et seq.

November 20, 2023 1264 Bulletin No. 2023–47
the PHS Act.
21
These rules implement
provisions to protect consumers from
surprise medical bills for emergency ser-
vices, non-emergency services furnished
by nonparticipating providers for patient
visits to participating facilities
22
in certain
circumstances, and air ambulance services
furnished by nonparticipating providers
of air ambulance services. These rules
also implement provisions to establish a
Federal IDR process to determine payment
amounts when there is a dispute between
plans or issuers and providers, facilities, or
providers of air ambulance services about
the out-of-network rate for these services
if a specified State law as defined in 26
CFR 54.9816-3T, 29 CFR 2590.716-3, and
45 CFR 149.30 or an applicable All-Payer
Model Agreement under section 1115A of
the Social Security Act does not provide a
method for determining the total amount
payable.
The July 2021 interim final rules and
October 2021 interim final rules gener-
ally apply to plans and issuers (including
grandfathered health plans) for plan years
(in the individual market, policy years)
beginning on or after January 1, 2022, and
to health care providers, facilities, and pro-
viders of air ambulance services for items
and services furnished during plan years
(in the individual market, policy years)
beginning on or after January 1, 2022.
23

The August 2022 final rules became effec-
tive October 25, 2022, and are applicable
for items or services provided or furnished
on or after October 25, 2022 for plan years
(in the individual market, policy years)
beginning on or after January 1, 2022.
B. October 2021 Interim Final Rules and
Related Guidance
The October 2021 interim final rules
implement the Federal IDR process under
sections 9816(c) and 9817(b) of the Code,
24

sections 716(c) and 717(b) of ERISA,
25

and sections 2799A-1(c) and 2799A-2(b)
of the PHS Act.
26
The rules apply to emer-
gency services, non-emergency services
furnished by nonparticipating providers
for patient visits to certain types of par-
ticipating health care facilities
27
(unless an
individual has been provided notice and
waived the individual’s surprise billing
protections, in accordance with 45 CFR
149.410 or 149.420, as applicable), and
air ambulance services furnished by non-
participating providers of air ambulance
services, for situations in which neither a
specified State law as defined in 26 CFR
54.9816-3T, 29 CFR 2590.716-3, and
45 CFR 149.30 nor an All-Payer Model
Agreement under section 1115A of the
Social Security Act applies.
To implement the Federal IDR pro-
cess, the October 2021 interim final rules
include requirements governing the costs
of the Federal IDR process. Under sec-
tion 9816(c)(5)(F)(i) of the Code,
28
sec-
tion 716(c)(5)(F)(i) of ERISA,
29
section
2799A-1(c)(5)(F)(i) of the PHS Act,
30

and the October 2021 interim final rules,
the party whose offer is not selected is
responsible for the payment of the fee
charged by the certified IDR entity (certi-
fied IDR entity fee).
31
Under the October
2021 interim final rules, as a condition of
certification, the certified IDR entity must
notify the Departments of the amount of
the certified IDR entity fees it intends to
charge for payment determinations, which
is limited to a fixed certified IDR entity
fee amount for single determinations and
a separate fixed certified IDR entity fee
amount for batched determinations.
32
Each
of these fixed certified IDR entity fees
must be within a range set forth in guid-
ance by the Departments, unless the certi-
fied IDR entity receives written approval
from the Departments to charge a certified
IDR entity fee outside that range.
33
The
October 2021 interim final rules describe
the considerations that the Departments
will use to develop the certified IDR entity
fee ranges, including the anticipated time
and resources needed for certified IDR
entities to meet the requirements of those
interim final rules, the volume of payment
determinations, and the adequacy of the
Federal IDR process capacity to efficiently
handle the volume of IDR initiations and
payment determinations, and discuss that
the Departments will review and update
the allowable fee ranges annually based
on these factors, the impact of inflation,
and other cost increases. Those rules also
provide that on an annual basis, the cer-
tified IDR entity may update its certified
IDR entity fees within the ranges set forth
in current guidance and seek approval
from the Departments to charge fixed cer-
tified IDR entity fees beyond the upper or
lower limits for certified IDR entity fees.
34

Additionally, pursuant to section
9816(c)(8) of the Code,
35
section 716(c)(8)
of ERISA,
36
and section 2799A-1(c)(8) of
the PHS Act,
37
and under the October 2021
21
42 U.S.C. 300gg–111, et seq. and 42 U.S.C. 300gg–112, et seq.
22
References to a “participating facility” in this preamble mean a “participating health care facility,” as defined at 26 CFR 54.9816-3T, 29 CFR 2590.716-3, and 45 CFR 149.30.
23
The interim final rules also include interim final regulations under 5 U.S.C. 8902(p) issued by OPM that specify how certain provisions of the No Surprises Act apply to health benefit plans
offered by carriers under the Federal Employees Health Benefits Act. These provisions apply to carriers in the FEHB Program with respect to contract years beginning on or after January 1,
2022. The disclosure requirements at 45 CFR 149.430 regarding patient protections against balance billing are applicable as of January 1, 2022.
24
26 U.S.C. 9816(c) and 26 U.S.C. 9817(b).
25
29 U.S.C. 1185e(c) and 29 U.S.C. 1185f(b).
26
42 U.S.C. 300gg–111(c) and 42 U.S.C. 300gg–112(b).
27
A health care facility, in the context of non-emergency services, is defined as (1) a hospital (as defined in section 1861(e) of the Social Security Act), (2) a hospital outpatient department,
(3) a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act), or (4) an ambulatory surgical center described in section 1833(i)(1)(A) of the Social Security Act.
Code section 9816(b)(2)(A)(ii), ERISA section 716(b)(2)(A)(ii), and PHS Act section 2799A–1(b)(2)(A)(ii). 26 CFR 54.9816-3T, 29 CFR 2590.716-3, and 45 CFR 149.30.
28
26 U.S.C. 9816(c)(5)(F)(i).
29
29 U.S.C. 1185e(c)(5)(F)(i).
30
42 U.S.C. 300gg–111(c)(5)(F)(i).
31
In the case of a batched dispute, the party with fewest determinations in its favor is considered the non-prevailing party and is responsible for paying the certified IDR entity fee. In the event
that each party prevails in an equal number of determinations, the certified IDR entity fee will be split evenly between the parties. 86 FR 55980, 56001.
32
26 CFR 54.9816-8T(e)(2)(vii), 29 CFR 2590.716-8(e)(2)(vii), and 45 CFR 149.510(e)(2)(vii).
33
Id.
34
Id.
35
26 U.S.C. 9816(c)(8).
36
29 U.S.C. 1185e(c)(8).
37
42 U.S.C. 300gg–111(c)(8).

Bulletin No. 2023–47 1265 November 20, 2023
interim final rules, each party must pay an
administrative fee for participating in the
Federal IDR process. The administrative
fee is established in guidance in a manner
so that, in accordance with the require-
ments of section 9816(c)(8)(B) of the
Code,
38
section 716(c)(8)(B) of ERISA,
39

and section 2799A-1(c)(8)(B) of the PHS
Act,
40
the total administrative fees paid
for a year are estimated to be equal to the
amount of expenditures estimated to be
made by the Departments to carry out the
Federal IDR process for that year.
41
Contemporaneously with the October
2021 interim final rules, the Departments
released the Calendar Year 2022 Fee
Guidance for the Federal Independent
Dispute Resolution Process Under the
No Surprises Act (October 2021 guid-
ance), setting the administrative fee
for both parties to a dispute at $50 per
party.
42
The October 2021 guidance also
established the range for fixed certified
IDR entity fees for single determinations
as $200–$500, and the range for fixed
certified IDR entity fees for batched
determinations as $268–$670, unless
otherwise approved by the Departments.
In October 2022, the Departments
released the Calendar Year 2023 Fee
Guidance for the Federal Independent
Dispute Resolution Process Under the
No Surprises Act (October 2022 guid-
ance), again setting the administrative
fee for both parties to a dispute at $50
per party.
43
The October 2022 guidance
explained that the data available regard-
ing take-up and usage of the Federal
IDR process was not reliable enough to
support a change to either the estimated
number of payment determinations for
which administrative fees would be paid
or the estimated ongoing program costs
for 2023; therefore, the 2023 adminis-
trative fee amount due from each party
for participating in the Federal IDR pro-
cess would remain the same as the 2022
administrative fee. The October 2022
guidance permits certified IDR entities to
charge a fee between $200 and $700 for
single determinations and between $268
and $938 for batched determinations,
unless the Departments otherwise grant
approval for the certified IDR entity to
charge a fee outside of these ranges. In
addition, to account for the heightened
workload for batched determinations, the
October 2022 guidance permits a certi-
fied IDR entity to charge the following
percentage of its approved certified IDR
entity batched determination fee (“batch-
ing percentage”) for batched determina-
tions, which are based on the number of
line items initially submitted in the batch:
• 2-20 line items: 100 percent of the
approved batched determination fee;
• 21-50 line items: 110 percent of the
approved batched determination fee;
• 51-80 line items: 120 percent of the
approved batched determination fee;
and
• 81 line items or more: 130 percent of
the approved batched determination
fee.
In December 2022, the Departments
released the Amendment to the Calendar
Year 2023 Fee Guidance for the Federal
Independent Dispute Resolution Process
Under the No Surprises Act (December
2022 guidance), which amended the
$50 per party administrative fee set in
the October 2022 guidance to $350 for
calendar year 2023.
44
The change in the
administrative fee for 2023 reflected
the additional costs to the Departments
to carry out the Federal IDR process as
a result of the Departments’ enhanced
role in calendar year 2023 in conducting
pre-eligibility reviews to allow the certi-
fied IDR entities to complete their eligi-
bility determinations more efficiently,
45

as well as systemic improvements that
allowed for the aggregation of data needed
to estimate the rate at which disputes were
determined eligible for the Federal IDR
process and the rate at which one or both
parties paid the administrative fee for pur-
poses of calculating the administrative
fee. The December 2022 guidance did not
amend the certified IDR entity fee ranges.
C. Recent Litigation
On November 30, 2022, the Texas
Medical Association, Tyler Regional
Hospital, and a Texas physician filed
a lawsuit (TMA III)
46
against the
Departments and OPM, asserting that the
July 2021 interim final rules
47
and certain
related guidance documents were in con-
flict with the statutory language, including
the regulations governing how the quali-
fying payment amount (QPA) should be
calculated. On August 24, 2023, the U.S.
District Court for the Eastern District of
Texas (Texas District Court) issued a
memorandum opinion and order
48
that
vacated certain portions of the July 2021
interim final rules and associated regula-
tory provisions
49
and portions of guidance
38
26 U.S.C. 9816(c)(8)(B).
39
29 U.S.C. 1185e(c)(8)(B).
40
42 U.S.C. 300gg–111(c)(8)(B).
41
26 CFR 54.9816-8T(d)(2)(ii), 29 CFR 2590.716-8(d)(2)(ii), and 45 CFR 149.510(d)(2)(ii).
42
Centers for Medicare & Medicaid Services (September 30, 2021). Calendar Year 2022 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act.
https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Technical-Guidance-CY2022-Fee-Guidance-Federal-Independent-Dispute-Resolution-Process-NSA.pdf.
43
Centers for Medicare & Medicaid Services (October 31, 2022). Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act.
https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf.
44
Centers for Medicare & Medicaid Services (December 23, 2022). Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the
No Surprises Act: Change in Administrative Fee. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/amended-cy2023-fee-guidance-federal-independent-dispute-re-
solution-process-nsa.pdf.
45
Centers for Medicare & Medicaid Services (November 21, 2022). Notice of the Federal Independent Dispute Resolution (IDR) Team Technical Assistance to Certified Independent Dispute
Resolution Entities (IDREs) in the Dispute Eligibility Determination Process. https://www.cms.gov/files/document/idre-eligibility-support-guidance-11212022-final-updated.pdf.
46
Tex. Med. Ass’n, v. U. S. Dep’t of Health and Human Servs., Case No. 6:22-cv-00450-JDK (E.D. Tex. November 30, 2022).
47
86 FR 36872 (July 13, 2021).
48
See Memorandum Opinion and Order, Tex. Med. Ass’n. v. U.S. Dep’t of Health & Hum. Servs, No. 6:22-cv-00450-JDK (E.D. Tex. August 24, 2023).
49
Specifically, the Texas District Court vacated certain subprovisions of 45 CFR § 149.130 and 149.140, 26 CFR § 54.9816-6T and 54.9817-1T, and 29 CFR § 2590.716-6 and 2590.717-1.
The Texas District Court also vacated 5 CFR § 890.114(a).

November 20, 2023 1266 Bulletin No. 2023–47
documents,
50
including those portions that
provided the methodology for calculating
the QPA and interpretations for certified
IDR entities related to the processing of
disputes for air ambulance services.
On January 30, 2023, the Texas
Medical Association, Houston Radiology
Associated, Texas Radiological Society,
Tyler Regional Hospital, and a Texas phy-
sician filed a lawsuit (TMA IV)
51
against
the Departments and OPM, asserting that
the December 2022 guidance was unlaw-
fully issued without notice and comment
rulemaking.
52
On August 3, 2023, the
Texas District Court issued a memoran-
dum opinion and order
53
that vacated the
portion of the December 2022 guidance
54

that increased the administrative fee for
the Federal IDR process to $350 per party
for disputes initiated during the calen-
dar year beginning January 1, 2023. The
Texas District Court also vacated certain
provisions of the October 2021 interim
final rules setting forth the batching cri-
teria under which multiple IDR items or
services are treated as related to the “treat-
ment of a similar condition.”
55
As a result of the TMA IV opinion and
order, on August 3, 2023, the Departments
instructed certified IDR entities to pause
all work in the Federal IDR portal until the
Departments updated the Federal IDR pro-
cess guidance, systems, and related docu-
ments to make them consistent with the
TMA IV opinion and order. Subsequently,
on August 7, 2023, the Departments
directed certified IDR entities to resume
processing all single and bundled dis-
putes for which the administrative fee
had already been paid and all batched dis-
putes for which the certified IDR entity
had already determined the dispute to be
eligible and administrative fees had been
paid (or the deadline for collecting fees
had expired) before August 3, 2023. On
August 8, 2023, the Departments directed
certified IDR entities to resume process-
ing single and bundled disputes initiated
in 2022 for which the administrative fee
had not been paid before August 3, 2023.
On August 11, 2023, the Departments
released guidance
56
to reflect the TMA
IV decision related to the administrative
fee and to clarify the applicability of the
$50 per party per dispute administrative
fee amount for 2023, as provided in the
October 2022 guidance. On the same
date, the Departments directed certified
IDR entities to resume processing single
and bundled disputes initiated in 2023 for
which the administrative fees had not been
paid before August 3, 2023. As a result of
the TMA III opinion and order issued on
August 24, 2023, the Departments again
paused all IDR-related activities in order
to evaluate the Texas District Court’s order
and review current Federal IDR processes,
templates, and system updates that are
necessary to comply with the order. As of
the publication of this proposed rulemak-
ing, the Departments have directed certi-
fied IDR entities only to perform limited
Federal IDR process functions.
D. Scope and Purpose of Rulemaking
These rules propose amendments to 26
CFR 54.9816-8(d)(2)(ii) and (e)(2)(vii),
29 CFR 2590.716-8(d)(2)(ii) and (e)(2)
(vii), and 45 CFR 149.510(d)(2)(ii) and
(e)(2)(vii) to provide that the administra-
tive fee amount and the ranges for certi-
fied IDR entity fees for single and batched
disputes would be set by the Departments
through notice and comment rulemaking,
rather than in guidance published annu-
ally. This rulemaking also proposes to set
forth the methodology used to calculate
the administrative fee and the consider-
ations used to develop the certified IDR
entity fee ranges. These rules would also
propose the administrative fee amount and
certified IDR entity fee ranges for disputes
initiated on or after the later of the effec-
tive date of these rules or January 1, 2024.
II. Overview of the Proposed Rules—
Departments of the Treasury, Labor, and
HHS
A. Administrative Fee Amount and
Methodology
Under section 9816(c)(8)(A) of the
Code,
57
section 716(c)(8)(A) of ERISA,
58

section 2799A-1(c)(8)(A) of the PHS
Act,
59
and the October 2021 interim final
rules,
60
each party to a determination for
which a certified IDR entity is selected
must pay an administrative fee for partic-
ipating in the Federal IDR process. Under
section 9816(c)(8)(B) of the Code,
61
sec-
tion 716(c)(8)(B) of ERISA,
62
section
2799A-1(c)(8)(B) of the PHS Act,
63
and
the October 2021 interim final rules,
64
the
administrative fee is established in a man-
ner such that the total administrative fees
50
Specifically, the Texas District Court vacated FAQs 14 and 15 of FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 55 (August 19, 2022),
as well as portions of Technical Guidance for Certified IDR Entities at 2-3 (August 18, 2022).
51
Tex. Med. Ass’n, v. U. S. Dep’t of Health and Human Servs., Case No. 6:23-cv-00059-JDK (E.D. Tex. January 30, 2023).
52
See Motion for Summary Judgment and Reply in Support of Summary Judgment, p. 1, Tex. Med. Ass’n. v. U.S. Dep’t of Health & Hum. Servs, No. 6:23-cv-00059-JDK (E.D. Tex. March
27, 2023). https://ecf.txed.uscourts.gov/doc1/175113317945.
53
See Memorandum Opinion and Order, Tex. Med. Ass’n. v. U.S. Dep’t of Health & Hum. Servs, No. 6:23-cv-00059-JDK (E.D. Tex. August 3, 2023).
54
Centers for Medicare & Medicaid Services (December 23, 2022). Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the
No Surprises Act: Change in Administrative Fee. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/amended-cy2023-fee-guidance-federal-independent-dispute-re-
solution-process-nsa.pdf.
55
Specifically, the Texas District Court vacated the requirement under 26 CFR 54.9816-8T(c)(3)(i)(C), 29 CFR 2590.716-8(c)(3)(i)(C), and 45 CFR 149.510(c)(3)(i)(C) that for a qualified
IDR item and service to be considered the same or similar item and service, it must be billed under the same service code or a comparable code under a different procedural code system,
such as the Current Procedural Terminology (CPT) codes with modifiers, if applicable, Healthcare Common Procedure Coding System (HCPCS) with modifiers, if applicable, or Diagnosis-
Related Group (DRG) codes with modifiers, if applicable.
56
Centers for Medicare & Medicaid Services (August 11, 2023). Federal Independent Dispute Resolution (IDR) Process Administrative Fee FAQs. https://www.cms.gov/cciio/resources/
regulations-and-guidance/downloads/no-surprises-act-independent-dispute-resolution-administrative-fee-frequently-asked-questions.pdf.
57
26 U.S.C. 9816(c)(8)(A).
58
29 U.S.C. 1185e(c)(8)(A).
59
42 U.S.C. 300gg–111(c)(8)(A).
60
26 CFR 54.9816-8T(d)(2)(i), 29 CFR 2590.716-8(d)(2)(i), and 45 CFR 149.510(d)(2)(i).
61
26 U.S.C. 9816(c)(8)(B).
62
29 U.S.C. 1185e(c)(8)(B).
63
42 U.S.C. 300gg–111(c)(8)(B).
64
26 CFR 54.9816-8T(d)(2)(ii), 29 CFR 2590.716-8(d)(2)(ii), and 45 CFR 149.510(d)(2)(ii).

Bulletin No. 2023–47 1267 November 20, 2023
paid for a year are estimated to be equal
to the amount of expenditures estimated to
be made by the Departments to carry out
the Federal IDR process for that year.
In TMA IV,
65
the Texas District Court
issued an opinion and order holding that
the process by which the Departments
amended the 2023 administrative fee guid-
ance to increase the administrative fee for
the Federal IDR process from $50 to $350
per party for disputes initiated during the
calendar year beginning January 1, 2023
66

was a violation of the Departments’ obli-
gation under the Administrative Procedure
Act to give affected parties notice of and
an opportunity to comment on the admin-
istrative fee.
67
In light of the Texas District
Court’s opinion and order, as well as the
Departments’ reassessment regarding the
practicability of establishing the admin-
istrative fee through notice and comment
rulemaking, the Departments propose to
establish the amount of the administrative
fee through notice and comment rulemak-
ing. To reflect this, the Departments pro-
pose to amend 26 CFR 54.9816-8(d)(2)
(ii), 29 CFR 2590.716-8(d)(2)(ii), and
45 CFR 149.510(d)(2)(ii) to state that the
Departments will set the administrative fee
through notice and comment rulemaking.
The Departments also propose at
26 CFR 54.9816-8(d)(2)(ii), 29 CFR
2590.716-8(d)(2)(ii), and 45 CFR
149.510(d)(2)(ii) that, for disputes ini-
tiated on or after the later of the effec-
tive date of these rules or January 1,
2024, the proposed administrative fee
amount would be $150 per party per dis-
pute, which would remain in effect until
changed by subsequent rulemaking. Under
this proposed rule, the Departments pro-
pose to retain the flexibility to update the
administrative fee more frequently or less
frequently than annually. With this flexi-
bility, the Departments intend to update
the administrative fee amount when the
total projected amount of administra-
tive fees paid or projected expenditures
made by the Departments to carry out the
Federal IDR process changes, such that
a new administrative fee amount would
be required for the Departments to cover
the costs of carrying out the Federal IDR
process. For example, the Departments’
expenditures may be impacted by changes
to regulations governing the Federal IDR
process or the implementation of that pro-
cess, the volume of disputes initiated and
closed under the Federal IDR process, and
the Departments’ costs. In such cases, the
Departments would propose a different
administrative fee amount in notice and
comment rulemaking before applying a
new administrative fee amount. Thus,
the proposal to amend the current regula-
tion to remove the requirement to set the
administrative fee amount annually would
help mitigate the risk of the Departments
being unable to collect administrative fees
sufficient to carry out the Federal IDR pro-
cess in response to evolving conditions,
such as the rates at which disputes are
being initiated and closed. Additionally,
the Departments could determine that the
projected amount of administrative fees
paid at the current fee amount will equal
the projected expenditures made to carry
out the Federal IDR process in a subse-
quent year, and therefore, no adjustment
of the fee amount in rulemaking would be
necessary. This proposed approach would
comport with the statutory requirement
to set the administrative fee amount in a
manner such that the total amount of fees
paid in a year is estimated to be equal to
the amount of expenditures estimated to
be made by the Departments in such year
in carrying out the Federal IDR process.
The Departments propose to set the
administrative fee amount by projecting
the amount of expenditures to be made
by the Departments in carrying out the
Federal IDR process and dividing this
by the projected number of administra-
tive fees to be paid by the parties. The
Departments project the number of admin-
istrative fees to be paid based on the total
volume of disputes to be closed. Under
the current Federal IDR process and
the policies proposed in these proposed
rules, both the initiating and non-initi-
ating parties to a dispute are required to
pay the non-refundable administrative fee
in full, and therefore the total amount of
administrative fees paid is calculated to
reflect that both parties to a dispute pay
the administrative fee. In calculating the
Departments’ estimated administrative
fee, the Departments use the total volume
of disputes projected to be closed, rather
than the total volume of disputes projected
to be initiated, because the total volume of
closed disputes is more indicative of the
total volume of disputes for which fees are
paid under the Departments’ current col-
lections process.
68
For the purposes of calculating the
administrative fee amount proposed in
this rulemaking, the Departments proj-
ect approximately 225,000 disputes will
be closed annually. This projection is
based on Federal IDR process data from
February 2023 through July 2023, which
is the most recent 6-month period before
Federal IDR process operations were
temporarily paused in August 2023.
69

Using this projected volume of disputes,
the Departments assume a prospective
reduction of approximately 25 percent in
the volume of closed disputes to account
for the impact of the TMA IV opinion and
order’s vacatur of the batching regulations
at 26 CFR 54.9816-8T(c)(3)(i)(C), 29
CFR 2590.716-8(c)(3)(i)(C), and 45 CFR
149.510(c)(3)(i)(C). The Departments
anticipate that the vacatur of the batching
regulations as a result of TMA IV discussed
in sections I.C. and II.B. of this preamble
65
6:23-cv-00059-JDK (E.D. Tex. Jan. 30, 2023).
66
Centers for Medicare & Medicaid Services (December 23, 2022). Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the
No Surprises Act: Change in Administrative Fee. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/amended-cy2023-fee-guidance-federal-independent-dispute-re-
solution-process-nsa.pdf.
67
See Memorandum Opinion and Order, Tex. Med. Ass’n. v. U.S. Dep’t of Health & Hum. Servs, No. 6:23-cv-00059-JDK (E.D. Tex. August 3, 2023). https://ecf.txed.uscourts.gov/
doc1/175113317945.
68
Under current policy and guidance, the administrative fee may be collected by certified IDR entities up until the time the parties submit their offers, and therefore the administrative fee
is not collected for all disputes initiated. See, for example, Centers for Medicare & Medicaid Services (March 2023). Federal Independent Dispute Resolution (IDR) Process Guidance for
Certified IDR Entities. https://www.cms.gov/files/document/federal-idr-guidance-idr-entities-march-2023.pdf.
69
For this calculation, we used our Federal IDR process collections data from February 2023 through July 2023 to calculate the average monthly volume of disputes closed. We applied the
25 percent reduction described in this rule to the average monthly volume and multiplied this number by 12 to project the annual volume of closed disputes.

November 20, 2023 1268 Bulletin No. 2023–47
may result in the initiation and closure of
fewer disputes due to the possibility that
batched disputes may involve more line
items and take more time to close.
Additionally, to calculate the admin-
istrative fee amount proposed in this
rulemaking, the Departments projected
the expenditures to carry out the Federal
IDR process. These projected expendi-
tures include the Federal resources needed
to carry out the Federal IDR process, such
as personnel costs, as well as activities
included as part of contract costs, such
as resources used for targeted improve-
ments of the overall process. The costs
to the Departments for carrying out the
Federal IDR process in 2024 are pro-
jected to be approximately $70 million,
70

which includes contract costs and Federal
resources associated with:
• Maintaining the Federal IDR portal,
which is intended to make the parties’
and certified IDR entities’ experiences
using the portal more efficient, clear,
and streamlined;
• Certifying IDR entities and collecting
data from them, which is intended to
increase the number of certified IDR
entities, improving the speed of eli-
gibility and payment determinations,
and to assist the Departments in under-
standing where some efficiencies may
still be gained in the process;
• Conducting program integrity activ-
ities, such as QPA audits and IDR
decision audits, which are intended to
ensure program integrity of the Federal
IDR process by reducing and prevent-
ing errors in the Federal IDR process;
• Investigating relevant complaints,
which is intended to ensure compliance
with the Federal IDR process;
• Providing outreach to parties and tech-
nical assistance to certified IDR enti-
ties, which is intended to streamline
the experience and further improve the
speed and integrity of eligibility and
payment determinations;
• Collecting administrative fees, which
is intended to operationalize, maintain,
and oversee administrative fee collec-
tions from certified IDR entities;
• Assisting with eligibility determina-
tions when the volume of disputes sub-
mitted exceeds the capacity of certified
IDR entities to perform those determi-
nations, which is intended to expedite
and facilitate eligibility reviews con-
ducted by certified IDR entities;
71
and
• Retaining and making available
Federal personnel dedicated to carry-
ing out Federal IDR process activities.
Using this methodology, as proposed
in paragraphs 26 CFR 54.9816-8(d)(2)(ii),
29 CFR 2590.716-8(d)(2)(ii), and 45 CFR
149.510(d)(2)(ii), the proposed adminis-
trative fee for disputes initiated on or after
the later of the effective date of these rules
or on January 1, 2024, and continuing until
changed by subsequent rulemaking, would
be calculated by dividing the projected
annual expenditures of approximately $70
million to be made by the Departments in
carrying out the Federal IDR process by
the projected annual number of admin-
istrative fees to be paid by the disputing
parties. As previously explained, the pro-
jected total number of administrative fees
is calculated using the projected volume
of disputes closed and reflects that both
parties to a dispute pay the administrative
fee. We project 225,000 closed disputes
in calendar year 2024. Therefore,450,000
administrative fees would be paid by
the parties in the year, because initiating
and non-initiating parties to a dispute are
required to pay the full administrative fee
under the current Federal IDR process.
This would result in a proposed adminis-
trative fee amount of $150 per party per
dispute.
72
This administrative fee amount
is based on the most current collections
data (February through July 2023), which
the Departments have determined to be
the best available data for estimation of
future collections, and the Departments’
projected expenditures as of the publica-
tion of these proposed rules. These projec-
tions may change between the publication
of the proposed and final rules based on
more recent data available at that time;
thus, the Departments propose to finalize
an administrative fee amount methodol-
ogy proposed here, as finalized, using the
updated data, if applicable.
The Departments continue to con-
sider improvements to the Federal IDR
process, including how collection of the
administrative fee could be more efficient
and how the administrative fee amount
could better ensure equitable access to
the Federal IDR process across the var-
ious parties seeking to initiate disputes.
Accordingly, the Departments intend to
propose additional policies related to the
administrative fee in future notice and
comment rulemaking, including policies
that would change the manner and time-
frame in which the administrative fee is
paid, reduce the administrative fee amount
for disputes that are determined ineligible
or that involve low-dollar claims, and cod-
ify the consequences of failing to pay the
administrative fee. Therefore, it is likely
that these potential future proposals could
require changes to the administrative fee
amount, and any such change would be
set forth in future notice and comment
rulemaking.
The Departments solicit comments on
this proposal, including the methodology
used to calculate the administrative fee
amount and the proposed administrative
fee amount for disputes initiated on or
after the later of the effective date of these
rules or on January 1, 2024, as well as any
potential effects on interested parties as a
result of increasing the administrative fee
from $50 to $150 per party. For exam-
ple, the Departments solicit comments on
whether this proposed administrative fee
amount could be cost prohibitive for cer-
tain parties disputing low-dollar items and
services, and whether it would reduce the
number of disputes initiated in calendar
year 2024 and beyond. The Departments
also solicit comment on the proposal to
set the administrative fee amount more
frequently or less frequently than annu-
ally and whether the Departments should
70
Because the Departments generally are not permitted to publicly provide information that is confidential due to trade secrets associated with future contracting, the Departments are limited
in their ability to provide detailed information about projected total Federal IDR process expenditures. See 45 CFR 5.31(d).
71
Centers for Medicare & Medicaid Services (November 21, 2022). Notice of the Federal Independent Dispute Resolution (IDR) Team Technical Assistance to Certified Independent Dispute
Resolution Entities (IDREs) in the Dispute Eligibility Determination Process. https://www.cms.gov/files/document/idre-eligibility-support-guidance-11212022-final-updated.pdf.
72
As described later in this rule, we estimate that the proposed administrative fee of $150 per party, per dispute would result in an estimated annual collection approximately equal to the
projected annual expenditures of approximately $70 million.

Bulletin No. 2023–47 1269 November 20, 2023
instead retain the current policy that the
administrative fee amount is set annually.
Additionally, the Departments seek com-
ment on any implications of TMA III and
TMA IV that could impact these adminis-
trative fee proposals that are not already
noted in this proposed rulemaking.
Finally, the Departments solicit com-
ment on whether, in future years, they
should apply an inflationary adjustment,
such as the consumer price index for all
urban consumers (CPI-U), to the pro-
jected expenditures to be made by the
Departments in carrying out the Federal
IDR process when calculating the admin-
istrative fee amount each year and set forth
the adjusted administrative fee amount in
guidance, rather than in notice and com-
ment rulemaking, as long as there are no
other changes to the methodology.
B. Certified IDR Entity Fee Ranges
Under current regulations at 26 CFR
54.9816-8T(e)(2)(vii), 29 CFR 2590.716-
8(e)(2)(vii), and 45 CFR 149.510(e)(2)
(vii), the certified IDR entity fees for
single determinations and batched deter-
minations are set by the certified IDR
entities within the upper and lower limits
of ranges for each as set forth in guidance
issued annually by the Departments.
The Departments propose to amend
the provisions of the regulations estab-
lishing the ranges for certified IDR entity
fees for single and batched disputes to
refer to the ranges being established in
notice and comment rulemaking, rather
than in guidance. These changes would
be reflected at 26 CFR 54.9816-8(e)(2)
(vii), 29 CFR 2590.716-8(e)(2)(vii), and
45 CFR 149.510(e)(2)(vii), which would
specify that certified IDR entities must,
on an annual basis, provide a fixed fee for
single determinations and separate fixed
fees for batched determinations within the
upper and lower limits for each as set in
notice and comment rulemaking. Further,
the proposed rules would provide that the
certified IDR entity fee ranges established
by the Departments in rulemaking would
remain in effect until new certified IDR
entity fee ranges are changed by a sub-
sequent notice and comment rulemaking.
Under this approach, the Departments
would retain the discretion to update the
certified IDR entity fee ranges more or
less frequently than annually. Consistent
with the current process, the certified IDR
entity could not charge a fee outside the
limits set forth in rulemaking unless the
certified IDR entity or IDR entity seek-
ing certification receives advance written
approval from the Secretary to charge a
fixed fee beyond the upper or lower lim-
its. Finally, the Departments propose that
the certified IDR entity or IDR entity
seeking certification may seek advance
written approval from the Departments to
update its fees more frequently than once
annually.
The Departments propose that for dis-
putes initiated on or after the later of the
effective date of these rules or January
1, 2024, certified IDR entities would be
permitted to charge a fixed certified IDR
entity fee for single determinations within
the range of $200 to $840. This fee range
represents a 20 percent increase to the
upper limit from the 2023 single deter-
mination fee range.
73
The Departments
anticipate that the proposed range for sin-
gle determinations would only minimally
impact the fixed fees selected by certified
IDR entities. This is because the process
of arbitrating single determinations should
remain relatively predictable in 2024, as
these disputes have not been impacted by
the TMA IV decision. The Departments
expect that certified IDR entities would
continue to price their single determina-
tion fees competitively despite the pro-
posed increase in range. Nonetheless,
the Departments are of the view that an
increase to the upper limit of the range is
necessary to allow certified IDR entities
flexibility to set their fees in alignment
with their operating costs.
The Departments propose that for dis-
putes initiated on or after the later of the
effective date of these proposed rules, or
January 1, 2024, certified IDR entities
would be permitted to charge a fixed certi-
fied IDR entity fee for batched determina-
tions within the range of $268 to $1,173,
unless a fee not within that range is
approved by the Departments pursuant to
paragraphs 26 CFR 54.9816-8T(e)(2)(vii)
(A) and (B), 29 CFR 2590.716-8(e)(2)
(vii)(A) and (B), and 45 CFR 149.510(e)
(2)(vii)(A) and (B). This fee range rep-
resents a 25 percent increase to the upper
limit from the 2023 batched determination
fee range.
74
The Departments propose to
continue to use a tiered fee structure based
on the number of line items within the
batch.
75
Under this proposed rule, the cer-
tified IDR entities would be permitted to
charge a fixed tiered fee within the range
of $75 to $250 for every additional 25 line
items within a batched dispute beginning
with the 26th line item. A certified IDR
entity’s batched determination fee would
be applied to all batched disputes that
have between 2 and 25 line items. For
batched disputes with more than 25 line
items, the certified IDR entity fee would
be able to increase the base amount for
every additional 25 line items by a fixed
value between $75 and $250, as deter-
mined by the certified IDR entity. Unlike
the fixed certified IDR entity fee for sin-
gle and batched determinations, certified
IDR entities would not be able to seek
approval to charge a fee outside of the
tiered fee range for batched determina-
tions. It is the Departments’ view that the
ability to seek approval to charge a fee
outside of the fixed certified IDR entity
batched fee range is sufficiently flexible to
address any potential cost concerns. This
is because the certified IDR entities only
need the ability to set a fee outside one of
the two batched ranges’ upper and lower
73
Beginning January 1, 2023, certified IDR entities are permitted to charge a certified IDR entity fee for single determinations within the range of $200–$700. See Centers for Medicare &
Medicaid Services (October 31, 2022). Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act. https://www.cms.gov/cciio/
resources/regulations-and-guidance/downloads/cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf.
74
Beginning January 1, 2023, certified IDR entities are permitted to charge a certified IDR entity fee for batched determinations within a range of $268–$938. See Centers for Medicare &
Medicaid Services (October 31, 2022). Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act. https://www.cms.gov/cciio/
resources/regulations-and-guidance/downloads/cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf.
75
This was first proposed in the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act and implemented for all disputes ini-
tiated as of January 1, 2023. See Centers for Medicare & Medicaid Services (October 31, 2022). Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process
under the No Surprises Act. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf.

November 20, 2023 1270 Bulletin No. 2023–47
limits to set their overall batched fee in
a manner that allows them to cover their
expenses. Further, for batched determina-
tions, the fee range would not restrict the
application of the additional fixed tiered
fee for batched disputes. For example, if
a certified IDR entity had, in 2024, set
its batched determination fee at $1,000
(which would be within the fee range of
$268 to $1,173) and its tiered fee at $200
(which would be within the tiered fee
range of $75 to $250) for each additional
increment of 25 line items, and were to
be selected for a batched determination
with 53 line items (which corresponds
to 2 increments of 25 line items within
the tiered fee structure plus the batched
determination fee) it would be permitted
to charge $1,400 ($1,000 + ($200 x 2)) as
its batched determination fee in calendar
year 2024.
Further, the Departments propose that
the batched determination fee would con-
tinue to be based on the number of line
items included in the initiating party’s
initial submission of the batched dispute
to the Federal IDR process. This would
account for the time and effort required of
certified IDR entities in determining eli-
gibility for all line items within a batched
dispute such that they can ultimately make
a payment determination. These fee ranges
would apply until another set of fee ranges
were proposed and finalized through sub-
sequent notice and comment rulemaking.
If a certified IDR entity wishes to
charge a fee outside either of these pro-
posed ranges, it would continue to fol-
low the existing process for requesting
written approval from the Departments to
do so outlined in 26 CFR 54.9816-8T(e)
(2)(vii)(A) and (B), 29 CFR 2590.716-
8(e)(2)(vii)(A) and (B), and 45 CFR
149.510(e)(2)(vii)(A) and (B), which the
Departments do not propose to change in
this rulemaking.
During calendar year 2023, certified
IDR entities continue to incur high admin-
istrative costs due to the volume of dis-
putes and the complexity in determining
eligibility, as described in the December
2022 guidance.
76
These proposed ranges
reflect the significant administrative bur-
den, ongoing eligibility determination
challenges,
77
and the Departments’ desire
to allow more flexibility for certified
IDR entities to determine a fee that best
reflects their operating costs. Given the
wide variability of certified IDR entities’
operations, structures, staffing patterns,
and expenses, it is the Departments’ posi-
tion that the ranges should not overly
restrict the certified IDR entities’ abil-
ity to set their fees commensurate with
their costs. Instead, broad ranges that
allow certified IDR entities flexibility
to set their fees in accordance with their
own circumstances would allow them
to remain financially viable and encour-
age their continued participation in the
Federal IDR process. The Departments
acknowledge that broadening the certified
IDR entity fee ranges could have some
impact on the cost to parties to engage
in the Federal IDR process (discussed in
section IV.D.2. of this preamble) which
could implicate access to the Federal IDR
process. However, access to the Federal
IDR process is dependent on certified IDR
entities’ voluntary participation in that
process. Voluntary participation by certi-
fied IDR entities is only possible if they
are able to set their fees within ranges nec-
essary to cover their operating expenses.
If the Departments were to set fee ranges
that could not support the certified IDR
entities’ financial viability and certified
IDR entities declined to participate in the
Federal IDR process altogether, the goal
of access would be impaired.
78
Therefore,
the Departments have endeavored to
judiciously balance access concerns with
certified IDR entities’ interests and seek
comment on the balance proposed. In set-
ting the certified IDR entity ranges for dis-
putes initiated on or after the later of the
effective date of these rules or on January
1, 2024, the Departments considered:
• The anticipated time and resources
needed for certified IDR entities to
make payment determinations meeting
the requirements of the statute, rules,
and guidance ;
• The anticipated time and resources
needed for data reporting;
• The anticipated time and resources
needed for complying with audit
requirements;
• The anticipated volume of Federal IDR
initiations and payment determination
quality assessments;
• The anticipated volume of Federal IDR
initiations ineligible for the Federal
IDR process; and
• The level of complexity in determining
the eligibility of items and services for
the Federal IDR process.
After reviewing these considerations,
the Departments are of the opinion that a
20 percent increase in the upper limit of
the certified IDR entity fee range for sin-
gle determinations (from $200 to $840),
would provide certified IDR entities an
appropriate amount of flexibility in setting
a fixed fee for single determinations, tak-
ing into account the anticipated increase in
operational cost. The Departments relied
on these same considerations to develop
the proposed 25 percent increase in the
upper limit of the certified IDR entity
fee range for batched determinations, but
also took into account the TMA IV opin-
ion and order when proposing the range
for batched determinations and the asso-
ciated tiered fee based on the number of
line items. In particular, the Departments
have considered the impact of the TMA
IV opinion and order on the anticipated
76
See Centers for Medicare & Medicaid Services (December 23, 2022). Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under
the No Surprises Act: Change in Administrative Fee. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/amended-cy2023-fee-guidance-federal-independent-dis-
pute-resolution-process-nsa.pdf.
77
Between April 15, 2022 and March 31, 2023, disputing parties initiated 334,828 disputes through the Federal IDR portal. During that time, non-initiating parties challenged the eligibility of
122,781 disputes. Even if the non-initiating party does not challenge eligibility of the dispute, the certified IDR entity must review the dispute and confirm that it is eligible before the dispute
can proceed in the Federal IDR process. These reviews involve complex eligibility determinations that require certified IDR entities to expend considerable time and resources. Eligibility
challenges are described in the following documents: Centers for Medicare & Medicaid Services (August 19, 2022). Federal Independent Dispute Resolution Process Status Update. https://
www.cms.gov/files/document/federal-idr-process-status-update-august-2022.pdf and Centers for Medicare & Medicaid Services (April 27, 2023). Federal Independent Dispute Resolution -
Status Update. https://www.cms.gov/files/document/federal-idr-processstatus-update-april-2023.pdf.
78
Indeed, during the early implementation of the Federal IDR process, some certified IDR entities did temporarily halt their operations before the Departments provided additional batching
guidance in August 2022, see: U.S. Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of the Treasury (August 2022). Technical Assistance for
Certified Independent Dispute Resolution Entities. https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/Technical-Assistance-IDR-Entities-August-2022.pdf.

Bulletin No. 2023–47 1271 November 20, 2023
complexity of batched determinations to
inform the proposed increased base range
of $268 to $1,173 and proposed tiered fee
range of $75 to $250 based on the number
of line items in a batched dispute. Section
9816(c)(3)(A) of the Code,
79
section
716(c)(3)(A) of the ERISA,
80
and section
2799A–1(c)(3)(A) of the PHS Act
81
direct
the Departments to specify criteria under
which multiple qualified IDR items and
services are permitted to be considered
jointly as part of a single determination
by a certified IDR entity for purposes of
encouraging the efficiency (including min-
imizing costs) of the Federal IDR process.
These sections further require that items
and services may be considered as part of
a batched determination only if the items
and services are furnished by the same
provider or facility; payment for the items
and services are made by the same group
health plan or health insurance issuer;
such items and services are related to the
treatment of a similar condition; and the
items and services were furnished during
the 30-day period following the date on
which the first item or service included in
the batched determination was furnished,
or during an alternative period as deter-
mined by the Departments, for use in lim-
ited situations, such as by the consent of
the parties or in the case of low-volume
items and services, to encourage proce-
dural efficiency and minimize health plan
and provider administrative costs.
Since the TMA IV opinion and order
vacated 26 CFR 54.9816-8T(c)(3)(i)(C),
29 CFR 2590.716-8(c)(3)(i)(C), and 45
CFR 149.510(c)(3)(i)(C), which estab-
lished standards for determining when
multiple items or services relate to “the
treatment of a similar condition” for the
purpose of batched disputes,
82
the certified
IDR entities may no longer rely on the reg-
ulatory guidance provided to assist certi-
fied IDR entities when reviewing batched
disputes. Certified IDR entities must now
only rely upon statutory language when
determining whether multiple items or
services are related to the treatment of a
similar condition and are therefore appro-
priate to batch.
As explained in the preamble to the
October 2021 interim final rules, the
Departments originally adopted the batch-
ing standards in those rules to avoid com-
binations of unrelated claims of providers,
facilities, providers of air ambulance ser-
vices and plans and issuers in a single
dispute that could unnecessarily com-
plicate an IDR payment determination
and create inefficiencies in the Federal
IDR process. The Departments further
intended to reduce redundant IDR pro-
ceedings and streamline the certified IDR
entities’ decision-making processes. The
Departments anticipate that the change
in batching parameters introduced by the
vacatur of 26 CFR 54.9816-8T(c)(3)(i)
(C), 29 CFR 2590.716-8(c)(3)(i)(C), and
45 CFR 149.510(c)(3)(i)(C) will make
certified IDR entities’ responsibilities
and processes for eligibility and payment
determinations under the Federal IDR
process more complex and less certain.
This unpredictability increases the sys-
temic burden for certified IDR entities in
the administration of their duties. In addi-
tion, the vacatur of 26 CFR 54.9816-8T(c)
(3)(i)(C), 29 CFR 2590.716-8(c)(3)(i)(C),
and 45 CFR 149.510(c)(3)(i)(C) will also
likely increase the number of items or ser-
vices batched. Certified IDR entities have
indicated to the Departments that making
determinations on large batches of dis-
similar items and services is particularly
complex and burdensome. Based on cer-
tified IDR entities’ experiences during the
early stages of implementing the Federal
IDR process, prior to the Departments
having provided guidance regarding the
batching parameters in August 2022,
83

the Departments observed that confu-
sion related to the batching standards
for the same or similar items or services
contributed to increased complexity in
determining eligibility, which added time
and cost for certified IDR entities and
contributed to processing delays.
84
The
Departments anticipate that the changes
to batching standards will require certified
IDR entities to update their operations,
processes, and systems, demand greater
staff resources, and increase the time
needed to render eligibility determina-
tions, including determinations of whether
items or services may be submitted as a
batch. Therefore, the proposal to increase
the fee range for batched determinations
and apply a tiered fee for batched disputes
based on the number of line items would
allow certified IDR entities to be appropri-
ately compensated and ensure that Federal
IDR process costs are clear to parties in
advance of initiating the Federal IDR
process.
In finalizing the fee amounts, the
Departments intend to take into account
any updated data or assumptions as
applied to the factors considered in this
preamble to set the fee ranges.
The Departments do not propose to
change the process for certified IDR enti-
ties to set their fees.
85
Certified IDR enti-
ties will continue to be permitted to set
their fees within the ranges proposed in
these proposed rules, if finalized. Under
these proposed rules, a certified IDR entity
must receive the Departments’ advance
written approval to modify its fixed fees
more than once annually. If requesting to
set its fee more than once annually, the
certified IDR entity must submit to the
Departments for approval: (1) the fixed
fee that the certified IDR entity is seeking
to charge; (2) a description that reasonably
explains the circumstances that require a
change to its fee; and (3) a detailed descrip-
tion that reasonably explains how the
change to its fee will be used to mitigate
the effects of these circumstances. The
Departments would use their discretion
to determine if the explanations included
in the request demonstrate that the change
would ensure the certified IDR entity’s
financial viability and would not impose
on parties an undue barrier to accessing
the Federal IDR process. It is appropriate
to permit certified IDR entities to change
their fees more than once annually, with
79
26 U.S.C. 9816(c)(3)(A).
80
26 U.S.C. 9816(c)(3)(A).
81
42 U.S.C. 300gg–111(c)(3)(A).
82
See Memorandum Opinion and Order, Tex. Med. Ass’n. v. U.S. Dep’t of Health & Hum. Servs, No. 6:23-cv-00059-JDK (E.D. Tex. August 3, 2023). https://ecf.txed.uscourts.gov/
doc1/175113317945.
83
See U.S. Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of the Treasury (August 2022). Technical Assistance for Certified Independent Dispute
Resolution Entities. https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/Technical-Assistance-IDR-Entities-August-2022.pdf.
84
Id.
85
45 CFR 149.510(e)(2)(vii).

November 20, 2023 1272 Bulletin No. 2023–47
advance approval from the Departments,
as some certified IDR entities may adopt
more efficiencies throughout the year that
would allow them to charge a lower fee,
or if conditions of the Federal IDR pro-
cess fluctuate throughout the year, some
certified IDR entities may need to increase
their fees to cover operating expenses.
The Departments seek comment on
these proposals, including the proposed
fee ranges themselves. The Departments
solicit comment on whether in future years
they should apply an inflationary adjust-
ment consideration, such as the CPI-U,
to the considerations used to develop the
certified IDR entity fee ranges each year
and set forth the adjusted fee amount in
guidance, rather than notice and comment
rulemaking. The Departments also seek
comment on whether certified IDR enti-
ties should be allowed to set their fees
based on a structure other than a fixed fee
range for single disputes and tiered fees
for batched disputes within the ranges
proposed in these rules. Specifically, the
Departments seek comment on whether
certified IDR entities should have flexibil-
ity to set a per line item fee or a per unique
service code fee. The Departments have
considered that allowing a per line item
fee or a per unique service code fee could
better address the concern of unpredictable
batching practices imposing high burdens
on certified IDR entities. However, the
Departments acknowledge that these pric-
ing structures for batching could decrease
the accessibility of the Federal IDR pro-
cess for parties, particularly small pro-
viders. In addition, the Departments seek
comment on the proposed number of line
items in each additional batched tier. The
Departments seek comment on whether
the tiers should be set at 10 line items,
50 line items, or a different number than
the proposed tiered increments of 25 line
items. The Departments acknowledge the
need to strike the correct balance between
the line item increment and the amount of
resources expended by the certified IDR
entities to review those line items. The
Departments have considered if incre-
ments of 25 line items or higher might
impose too great a burden on the certified
IDR entities so as not to be commensurate
with the proposed tiered fee range avail-
able to them. However, the Departments
also acknowledge that setting the line item
increments lower than 25 line items would
further impact the cost to parties of sub-
mitting a dispute, and that the proposed
tiered fee range of $75 to $250 may not
be appropriate at smaller line item incre-
ments. The Departments seek comment on
whether the tiered fee for batched disputes
should be set at a percentage of the cer-
tified IDR entity’s batched determination
fee, similar to how the tiering for the 2023
calendar year were implemented, rather
than a dollar value range. The Departments
also seek comment on whether to provide
a fixed fee that all certified IDR entities
must charge beyond the proposed 25 line
items per additional 25 line items rather
than permitting a range for certified IDR
entities to choose from. More specifi-
cally, the Departments seek comment on
whether certified IDR entities should be
permitted to set their batched determi-
nation fee between $268 and $1,173 and
then be permitted to charge only an addi-
tional fixed dollar amount (for example,
$125, $150, $200, etc.) per additional
25 line items. The Departments seek
comment on the appropriateness of set-
ting a fixed dollar tiered fee structure for
batched disputes, since this could impact
the certified IDR entities’ operational
flexibility, and would limit their ability to
competitively price their fees. However,
the Departments are considering whether
establishing a fixed dollar tiered fee might
mitigate the risk of one or a few certified
IDR entities pricing their tiered fee for
batched disputes so low that they become
inundated with large batches and thus pro-
vide greater consistency across certified
IDR entities. The Departments are consid-
ering if this alternate approach would pro-
vide more consistency regarding the fees
charged by different certified IDR entities
and avoid potentially overburdening IDR
entities that select a low tiered fee for
batched disputes.
III. Severability
In the event that any portion of these
proposed rules, if finalized as proposed, is
declared invalid, the Departments intend
that the various aspects of the administra-
tive fee proposals and certified IDR entity
fee proposals, as finalized, be severable.
For example, if a court were to find unlaw-
ful all of the administrative fee proposals,
the Departments would still intend for
the certified IDR entity fee proposals to
stand, and vice versa. As another exam-
ple, if a court were to find unlawful the
proposals to establish both the adminis-
trative fee and the certified IDR entity fee
ranges more or less frequently than annu-
ally, the Departments would still intend
for the administrative fee amount and
certified IDR entity fee ranges to be (1)
established through notice and comment
rulemaking and (2) established in the
amount and ranges as proposed in these
proposed rules. Likewise, if a court were
to find unlawful the proposed adminis-
trative fee amount or methodology or the
certified IDR entity fee ranges or consid-
erations used to determine the fee ranges
as proposed in these proposed rules, the
Departments would still intend for the
administrative fee amount and certified
IDR entity ranges to be (1) established
through notice and comment rulemaking
and (2) established more or less frequently
than annually.
Thus, the Departments propose at
new paragraph 26 CFR 54.9816-8(d)(3)
(i), 29 CFR 2590.716-8(d)(3)(i), and 45
CFR 149.510(d)(3)(i) that any provision
of paragraph (d) or paragraphs (e)(2)(vii)
through (e)(2)(ix) held to be invalid or
unenforceable as applied to any person or
circumstance shall be construed so as to
continue to give the maximum effect to
the provision permitted by law, including
as applied to persons not similarly situated
or to dissimilar circumstances, unless such
holding is that the provision of these para-
graphs is invalid and unenforceable in all
circumstances, in which event the provi-
sion shall be severable from the remainder
of these paragraphs and shall not affect
the remainder thereof. The Departments
further propose at new paragraph 26 CFR
54.9816-8(d)(3)(ii), 29 CFR 2590.716-
8(d)(3)(ii), and 45 CFR 149.510(d)(3)(ii)
that the provisions in paragraphs (d) and
(e)(2)(vii) through (ix) are intended to be
severable from each other.
The Departments are of the view that
each of the proposals for the adminis-
trative fee amount and the certified IDR
entity fee ranges would still function sen-
sibly even if one or more of the propos-
als in these proposed rules, as finalized,
were found unlawful. For example, the
proposals to establish the administrative

Bulletin No. 2023–47 1273 November 20, 2023
fee amount and certified IDR entity fee
ranges in notice and comment rulemaking
would not depend on either the lawfulness
of the methodology used to determine the
administrative fee amount or the lawful-
ness of the considerations used in deter-
mining the certified IDR entity fee ranges,
or whether both would be established on
an annual basis or more or less frequently
than annually. The proposal to use notice
and comment rulemaking to establish
the fees specifies only the method the
Departments would use and does not
determine how frequently the fees would
be established or the methodology for the
administrative fee amount or the consider-
ations used to determine the certified IDR
entity fee ranges.
The Departments seek comment on
this approach.
IV. Economic Impact and Paperwork
Burden
A. Summary – Departments of Health and
Human Services and Labor
These proposed rules would establish
the administrative fee amount and the cer-
tified IDR entity fee ranges in notice and
comment rulemaking, as well as propose
the methodology for setting both fees.
The Departments have examined
the effects of these proposed rules as
required by Executive Order 13563 (76
FR 3821, January 21, 2011, Improving
Regulation and Regulatory Review);
Executive Order 12866 (58 FR 51735,
October 4, 1993, Regulatory Planning and
Review); Executive Order 14094 entitled
“Modernizing Regulatory Review” (April
6, 2023); the Regulatory Flexibility Act
(Pub. L. 96–354, enacted September 19,
1980, Pub. L. 96–354); section 1102(b)
of the Social Security Act (42 U.S.C.
1102(b)); section 202 of the Unfunded
Mandates Reform Act of 1995 (March
22, 1995, Pub. L. 104–4); and Executive
Order 13132 (64 FR 43255, August 10,
1999, Federalism).
B. Executive Orders 12866, 13563, and
14094 – Departments of Health and
Human Services and Labor
Executive Orders 12866, 13563, and
14094 direct Federal agencies to assess
all costs and benefits of available regula-
tory alternatives and if regulation is nec-
essary, to select regulatory approaches
that maximize net benefits (including
potential economic, environmental, pub-
lic health and safety effects, distributive
impacts, and equity). Executive Order
14094 entitled “Modernizing Regulatory
Review” (hereinafter, the Modernizing
E.O.) amends section 3(f)(1) of Executive
Order 12866 (Regulatory Planning and
Review). The amended section 3(f) of
Executive Order 12866 defines a “signif-
icant regulatory action” as an action that
is likely to result in a rule: (1) having an
annual effect on the economy of $200 mil-
lion or more in any 1 year (adjusted every
3 years by the Administrator of OMB’s
Office of Information and Regulatory
Affairs (OIRA) for changes in gross
domestic product), or adversely affect in
a material way the economy, a sector of
the economy, productivity, competition,
jobs, the environment, public health or
safety, or State, local, territorial, or tribal
governments or communities; (2) creating
a serious inconsistency or otherwise inter-
fering with an action taken or planned by
another agency; (3) materially altering the
budgetary impacts of entitlement grants,
user fees, or loan programs or the rights
and obligations of recipients thereof;
or (4) raising legal or policy issues for
which centralized review would meaning-
fully further the President’s priorities or
the principles set forth in this Executive
Order, as specifically authorized in a
timely manner by the Administrator of
OIRA in each case.
A regulatory impact analysis (RIA)
must be prepared for rules deemed signif-
icant under section 3(f)(1) ($200 million
or more in any 1 year). Although based
on the Departments’ estimates, OMB’s
OIRA has determined these rules are
not significant under section 3(f)(1), the
Departments have prepared an RIA that
to the best of their ability presents the
costs and benefits of these rules. OMB has
reviewed these proposed regulations, and
the Departments have provided the fol-
lowing assessment of their impact.
C. Need for Regulatory Action –
Departments of Health and Human
Services and Labor
The Departments propose to amend
the certified IDR entity and administrative
fee provisions of the rules for the Federal
IDR process to set the administrative fee
and the certified IDR entity fee ranges in
notice and comment rulemaking, as well
as propose the methodology for setting the
administrative fee and the considerations
for developing the certified IDR entity fee
ranges. The Departments are of the view
that these proposals would ensure that
disputing and other parties are sufficiently
notified and provided an opportunity to
comment on the fees associated with the
Federal IDR process.
D. Summary of Impacts and Accounting
Table – Departments of Health and
Human Services and Labor
The expected benefits and costs of
these proposed rules are summarized
in Table 1 and discussed in this section
of the preamble. In accordance with
OMB Circular A–4, Table 1 depicts an
accounting statement summarizing the
Departments’ assessment of the bene-
fits, costs, and transfers associated with
this regulatory action. The Departments
are unable to quantify all benefits and
costs of these proposed rules but have
sought, where possible, to describe these
non-quantified impacts. The effects in
Table 1 reflect non-quantified impacts
and estimated direct monetary costs
resulting from the provisions of these
proposed rules.

November 20, 2023 1274 Bulletin No. 2023–47
TABLE 1: Accounting Table
Accounting Statement
Benefits:
Non-Quantified:
● Increased interested party transparency as a result of the proposals to establish the administrative fee and certified IDR
entity fee ranges in notice and comment rulemaking, as well as the methodology for calculating the administrative fee amount
and the considerations for developing the certified IDR entity fee ranges.
Costs:EstimateYear DollarDiscount RatePeriod Covered
Annualized Monetized
($/Year)
$0.09 million20237 percent2023-2027
$0.08 million20233 percent2023-2027
Quantified:
● Costs to interested parties of $438,543 to review and interpret these rules in 2023.
Transfers:EstimateYear DollarDiscount RatePeriod Covered
Annualized Monetized
($/year)
$41.69 million20237 percent2023-2027
$42.55 million20233 percent2023-2027
Quantified:
● Transfers from disputing parties to the Federal government of approximately $45 million annually beginning in 2024 as
a result of the proposal to set the administrative fee amount at $150 per party per dispute initiated on or after the later of the
effective date of these rules or January 1, 2024.
● Transfers from disputing parties to certified IDR entities of approximately $9 million annually beginning in 2024 as a result
of the proposal to set the certified IDR entity fee ranges at $200-$840 for single determinations, $268-$1,173 for batched
determinations, and an additional $75-$250 for each 25 line items in excess of the first 25 line items.
1. Benefits
The primary benefit of this rulemaking
would be to allow the Federal IDR pro-
cess to function through establishing the
administrative fee amount and certified
IDR entity fee ranges in rulemaking and
establishing the amounts of these fees for
disputes initiated on or after the later of
the effective date of these rules or January
1, 2024. In response to the opinion and
order in TMA IV, these proposed rules are
necessary in order to set the administra-
tive fee amount. The primary non-quan-
tifiable benefit of these proposed rules
would be the continuation of a function-
ing Federal IDR process, which helps to
protect consumers from surprise medical
bills and helps providers to receive com-
pensation. Additional benefits specific to
each Federal IDR process fee type appear
in the following sections.
a. Administrative Fee Amount and
Methodology
The Departments are proposing to
establish the amount of the administrative
fee in notice and comment rulemaking for
disputes initiated on or after the later of
the effective date of these rules or January
1, 2024, as well as the methodology
for determining the administrative fee.
Utilizing notice and comment rulemaking
would increase transparency of the admin-
istrative fee setting process and allow
interested parties to provide feedback to
the Departments prior to the Departments
setting the administrative fee amount.
The Departments seek comment on these
assumptions.
b. Certified IDR Entity Fee Ranges
The Departments are proposing to
establish the certified IDR entity fee
ranges for single and batched determi-
nations, which include a tiered fee range
for batched determinations for disputes
that exceed 25 dispute line items, in
notice and comment rulemaking for dis-
putes initiated on or after the later of the
effective date of these rules or January
1, 2024. Utilizing notice and com-
ment rulemaking to set the appropri-
ate ranges for certified IDR entity fees
would increase transparency for parties
interested in the certified IDR entity
fee ranges and allow interested parties
to identify in advance the impacts of
changing the certified IDR entity fee
ranges. The Departments seek comment
on these assumptions.
2. Costs
a. Administrative Fee Amount and
Methodology
The Departments are proposing to
establish the amount of the administrative
fee in notice and comment rulemaking for
disputes initiated on or after the later of
the effective date of these rules or January
1, 2024, as well as proposing the meth-
odology for setting the administrative fee
amount, in response to the opinion and
order in TMA IV and to ensure that dis-
puting and other parties are sufficiently
notified and provided an opportunity to
comment on the certified IDR entity fee
ranges. The Departments are also propos-
ing the administrative fee amount for dis-
putes initiated on or after the later of the

Bulletin No. 2023–47 1275 November 20, 2023
effective date of these rules or January 1,
2024, at $150 per party per dispute.
The current administrative fee is $50
per party per dispute.
86
Based on Federal
IDR process data from February through
July 2023, as discussed in section II.A.
of this preamble, the Departments esti-
mate that approximately 225,000 disputes
are closed per year. Therefore, if the cur-
rent administrative fee were to remain
applicable, disputing parties would pay
approximately $22.5 million in adminis-
trative fees annually (225,000 disputes x
2 parties per dispute x $50 per party).
87

As the Departments are now proposing
an administrative fee of $150 for dis-
putes initiated on or after the later of the
effective date of these rules or January 1,
2024, the Departments estimate that dis-
puting parties would pay approximately
$67.5 million in administrative fees annu-
ally beginning in 2024 (225,000 disputes
x 2 parties per dispute x $150 per party),
assuming the number of disputes remains
stable year over year and the adminis-
trative fee amount is not subsequently
changed through notice and comment
rulemaking. Therefore, the costs associ-
ated with this proposal would be approx-
imately $45 million ($67.5 million if this
proposal is finalized – $22.5 million if the
status quo were to continue).
The Departments seek comment on
these estimates and assumptions.
b. Certified IDR Entity Fee Ranges
The Departments are proposing to set
the certified IDR entity fee ranges for sin-
gle and batched determinations, with a
tiered fee range for batched determination
for disputes that exceed 25 line items, in
notice and comment rulemaking for dis-
putes initiated on or after January 1, 2024
in response to the opinion and order in
TMA IV and to ensure that disputing and
other parties are sufficiently notified and
provided an opportunity to comment on
the certified IDR entity fee ranges. The
proposed certified IDR entity fee range
for single determinations for disputes ini-
tiated on or after the later of effective date
of these rules or January 1, 2024, would
be $200 to $840. The proposed certified
IDR entity fee range for batched determi-
nations for disputes initiated on or after
the later of the effective date of these
rules or January 1, 2024 would be $268
to $1,173. Further, the proposed tiered
fee range for batched determination for
disputes initiated on or after the later of
the effective date of these rules or January
1, 2024 would be $75 to $250. While
the certified IDR entities are responsi-
ble for setting their fees for single and
batched determinations, the Departments
acknowledge that the proposed changes to
the fee ranges may impact the cost to par-
ticipate in the Federal IDR process for the
parties. The Departments anticipate that
the vacatur of batching standards by the
Texas District Court’s opinion and order
in TMA IV could result in initiating parties
submitting single and batched disputes in
proportions similar to those prior to the
issuance of the August 2022 guidance,
which interpreted the standards for batch-
ing qualified IDR items or services. Based
on internal data prior to the establishment
of the now vacated batching criteria that
was released in August 2022, approxi-
mately 70 percent of disputes were single
disputes and approximately 30 percent
were batched disputes.
88
The Departments
anticipate that, as a result of TMA IV,
initiating parties will likely resume the
batching practices they engaged in prior
to issuance of the August 2022 guidance,
such as initiating a higher proportion of
batched disputes and including more items
or services within those batched disputes.
As discussed in section II.A. of this
preamble, the Departments estimate
that approximately 225,000 disputes are
closed annually. Further, the Departments
assume that certified IDR entities collect a
certified IDR entity fee on approximately
135,000 of those 225,000 closed disputes
annually.
89
Therefore, for the purposes of
this analysis, the Departments estimate
that certified IDR entities would collect
certified IDR entity fees on approximately
94,500 single disputes and 40,500 batched
disputes closed annually (135,000 x 0.70
and 135,000 x 0.30, respectively). The
Departments acknowledge that each party
must pay a certified IDR entity fee to the
certified IDR entity no later than the time
that party submits its offer. However,
because the non-prevailing party is ulti-
mately responsible for the full certified
IDR entity fee, which is retained by the
certified IDR entity for the IDR services
it performed, it is the Departments’ posi-
tion that providing a per-dispute calcula-
tion reasonably captures the overall cost
of the dispute without implicating false
precision on the amount of certified IDR
fee costs that initiating and non-initiating
parties ultimately may incur.
To develop a reasonable estimate for
the certified IDR entity fee amount for
both single and batched disputes, the
Departments assume that the certified IDR
entities would set single determination
fixed fees approximate to the median value
of the proposed fee range and would set
batched determination fixed fees approx-
imate to the 75
th
quartile of the proposed
fee range.
90
Therefore, for the purposes
of this analysis, the Departments estimate
that the average single determination fixed
86
As a result of the opinion and order in TMA IV, which vacated the portion of the December 2022 guidance that increased the administrative fee to $350 per party per dispute for disputes
initiated during calendar year 2023, the administrative fee amount reverted to the administrative fee amount established in the October 2022 guidance. See Centers for Medicare & Medicaid
Services (August 11, 2023). Federal Independent Dispute Resolution (IDR) Process Administrative Fee FAQs. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/
no-surprises-act-independent-dispute-resolution-administrative-fee-frequently-asked-questions.pdf. Also see Centers for Medicare & Medicaid Services (October 31, 2022). Calendar
Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act. https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/
cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf.
87
The numbers in this analysis assume that all parties pay the requisite administrative fee in all closed disputes.
88
The Departments estimate that currently approximately 80 percent of disputes are single disputes and 20 percent of disputes are batched disputes.
89
The Departments use the number of closed disputes for this analysis, as the certified IDR entity fee is due from the parties at the time the parties submit their offers, in accordance with 26
CFR 54.9816-8T(d)(1)(ii), 29 CFR 2590.716-8(d)(1)(ii), and 45 CFR 149.510(d)(1)(ii). Therefore, using the number of initiated disputes for this analysis would be inappropriate as not all
initiated disputes proceed to the offer submission stage if, for example, they are determined to be ineligible for the Federal IDR process.
90
Currently, the median of the calendar year 2023 certified IDR entity fees is $549 for single determinations and $770 for batched determinations, which are approximately the upper quartiles
of the 2023 certified IDR entity fee ranges for single determinations ($200-$700) and batched determinations ($268-$938). The Departments anticipate that, due to the uncertainty around
batching practices as a result of the TMA IV opinion and order, the certified IDR entities will likely choose to increase their batched determination fee. Therefore, using the 75
th
percentile of
the proposed fee range to calculate the cost of batched determinations provides a reasonable approximation of the expected increase.

November 20, 2023 1276 Bulletin No. 2023–47
fee (range $200–$840) would be approxi-
mately $520, and that the average batched
determination fixed fee (range $268–
$1,173) would be approximately $947. At
an estimated cost of $520 per single deter-
mination for approximately 94,500 single
determinations annually, the Departments
estimate that single determinations would
cost disputing parties approximately
$49,140,000 annually ($520 x 94,500).
At an estimated cost of $947 per batched
determination for approximately 40,500
batched determinations annually, the
Departments estimate that batched deter-
minations would cost disputing parties
approximately $38,353,500 annually
($947 x 40,500).
Further, the Departments estimate that
using the proposed tiered fee range for
batched determinations, certified IDR
entities would set and apply a fixed fee
approximate to the median of the proposed
range ($75–$250) for batched determina-
tions based on the number of dispute line
items. The Departments estimate that cer-
tified IDR entities would set their tiered
fee at $163 on average. The Departments
acknowledge the uncertainty surrounding
the number of line items that may be sub-
mitted in batched disputes due to the TMA
IV opinion. However, to produce an esti-
mate, and for the purposes of this analysis,
the Departments estimate that a subset of
approximately 4,455 batched determina-
tions would potentially be subject to at least
2 applications of the tiered fee ($163 x 2
= $326).
91
As such, the Departments esti-
mate that this subset of approximately
4,455 batched determinations exceeding
25 line items would cost disputing parties
approximately $1,452,330 annually ($326
x 4,455). In total, assuming the number of
disputes remains stable year over year, the
Departments estimate the parties would
pay approximately $89 million in certified
IDR entity fees annually if these proposals
are finalized as proposed ($49,140,000 for
single determinations + $38,353,500 for
batched determinations + $1,452,330 for
the subset of batched determinations sub-
ject to the tiered fee).
The calendar year 2023 certified IDR
entity fee ranges for single determinations
and batched determinations are $200–$700
and $268–$938, respectively. Certified
IDR entities currently charge a median
fixed fee of $549 for single determinations
and $770 for batched determinations in
2023. As such, for approximately 108,000
single determinations and 24,840 batched
determinations annually,
92
if current cer-
tified IDR entity fixed fees remained
applicable, the Departments estimate that
disputing parties would pay approximately
$59,292,000 for single determinations
($549 x 108,000) and $19,126,800 for
batched determinations ($770 x 24,840).
Current guidance permits certified IDR
entities to charge a batching percentage
on batched determinations based on the
number of dispute line items.
93
For the
purposes of this analysis, the Departments
assume that a subset of approximately 8
percent of batched determinations poten-
tially subject to the batched percentages
would at least receive a 120 percent
increase from the median batched deter-
mination fixed fee ($770 x 1.20). As such,
the Departments estimate that disputing
parties would pay approximately $2 mil-
lion for this subset of batched determi-
nations potentially subject to a batching
percentage (2,160 x $924), resulting in a
total cost of approximately $80 million
under the current calendar year 2023 certi-
fied IDR entity fee structure ($59,292,000
for single determinations + $19,126,800
for batched determinations + $2 million
for the subset of batched determinations
subject to the tiered fee). Therefore, tak-
ing into account the current costs to the
parties associated with the current cer-
tified IDR entity fee structure, the total
costs to disputing parties associated with
this proposal is approximately $9 million
($89 million if finalized as proposed - $80
million if the status quo fee ranges were
to continue).
The Departments seek comments on
these estimates and assumptions.
3. Uncertainties
It is unclear whether the Federal IDR
process would experience the same oper-
ating conditions, such as the number of
disputes initiated, future policy changes
finalized after future notice and comment
rulemaking, and increased or decreased
costs by the Departments to carry out the
Federal IDR process. Due to the need to
take point-in-time estimates of volume and
expenditures for the purposes of develop-
ing the analyses in these rules, there is
inherent uncertainty in the estimates in
these analyses as the data are constantly
changing. It is difficult to project the
impact on the administrative fee amount
charged to the parties if the Federal IDR
process landscape changes. Although the
Departments have analyzed the Federal
IDR process data available to inform their
projections, it is uncertain whether the
trends in this data will remain applica-
ble. The Federal IDR process is still in an
early phase of implementation and has not
yet achieved the stabilization that would
likely occur with long-term uptake of the
process. Initially, the Departments esti-
mated that approximately 22,000 disputes
would be submitted to the process each
year;
94
uptake of the process, however,
91
The Departments estimate that approximately 11 percent of batched disputes submitted prior to the establishment of the batching criteria released in August 2022 exceeded 25 dispute line
items.
92
The Departments estimate that 80 percent of disputes are single disputes and 20 percent are batched disputes (135,000 x 0.80 and 135,000 x 0.20, respectively). For the purpose of this
analysis, the Departments estimate that a subset of approximately 8 percent, or 2,160 batched determinations would be subject to a batching percentage (27,000 x 0.08).
93
Without the need to seek further approval, to account for the differential in the workload of batched determinations, a certified IDR entity may charge the following percentage of its
approved certified IDR entity batched determination fee (“batching percentage”) for batched determinations, which are based on the number of line items initially submitted in the batch:
●
2-20 line items: 100 percent of the approved batched determination fee;
●
21-50 line items: 110 percent of the approved batched determination fee;
●
51-80 line items: 120 percent of the approved batched determination fee; and
●
81 line items or more: 130 percent of the approved batched determination fee.

See Centers for Medicare & Medicaid Services (October 31, 2022). Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process under the No Surprises Act.
https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/cy2023-fee-guidance-federal-independent-dispute-resolution-process-nsa.pdf.
94
In the regulatory impact analysis of the October 2021 interim final rules, the Departments estimated that 17,333 disputes involving non-air ambulance services and 4,899 disputes involving
air ambulance services would be submitted to the Federal IDR process during the first year of implementation, totaling 22,232 anticipated disputes.

Bulletin No. 2023–47 1277 November 20, 2023
rapidly outpaced that estimate, as dis-
pute initiations have grown exponentially
since implementation, and analysis has
revealed an estimated number closer to
340,000 annual initiated disputes is cur-
rently more accurate. At the same time,
the Departments do not know what impact
changes to the batching policy as a result
of the Texas District Court’s opinion and
order in TMA IV will have on the number
of disputes being initiated and the time
that it will take certified IDR entities to
close those disputes.
4. Regulatory Review Cost Estimation
If regulations impose administrative
costs on entities, such as the time needed
to read and interpret rules, regulatory
agencies should estimate the total cost
associated with regulatory review. Based
on comments received for the July 2021
interim final rules and October 2021
interim final rules, the Departments esti-
mate that more than 2,100 entities will
review these proposed rules, including
1,500 issuers, 205 third party administra-
tors (TPAs), and at least 395 other inter-
ested parties (for example, State insurance
departments, State legislatures, industry
associations, advocacy organizations, and
providers and provider organizations).
The Departments acknowledge that this
assumption may understate or overstate
the number of entities that will review
these proposed rules.
Using the median hourly wage rate
from the Bureau of Labor Statistics for
a Lawyer (Code 23-1011) to account for
average labor costs (including a 100 per-
cent increase for the cost of fringe benefits
and other indirect costs), the Departments
estimate that the cost of reviewing these
proposed rules would be $130.52 per
hour.
95
The Departments estimate, based
on an estimated rule length of approx-
imately 22,000 words and an average
reading speed of 200 to 250 words per
minute, that it would take each reviewing
entity approximately 1.6 hours to review
these proposed rules, with an associ-
ated cost of approximately $208.83 (1.6
hours x $130.52 per hour). Therefore,
the Departments estimate that the total
burden to review these proposed rules
will be approximately 3,360 hours (2,100
reviewers x 1.6 hours per reviewer),
with an associated cost of approximately
$438,543 (2,100 reviewers x $208.83 per
reviewer).
The Departments welcome comments
on this approach to estimating the total
burden and cost for interested parties to
read and interpret these proposed rules.
E. Regulatory Alternatives – Departments
of Health and Human Services and Labor
In developing these proposed rules, the
Departments considered various alterna-
tive approaches.
1. Administrative Fee Amount and
Methodology (26 CFR 54.9816-8(d)(2),
29 CFR 2590.716-8(d)(2), and 45 CFR
149.510(d)(2))
In TMA IV, the Texas District Court indi-
cated that notice and comment rulemak-
ing is necessary to set the administrative
fee amount. In light of the Texas District
Court opinion and order, as well as the
Departments’ assessment regarding the
practicability of determining the admin-
istrative fee amount through notice and
comment rulemaking, the Departments
are of the view that alternative approaches
would lead to unwarranted uncertainty.
In addition, the Departments are of the
view that providing a description of the
methodology used to calculate the fee
amount and proposing the administrative
fee amount in these proposed rules would
increase transparency for the parties and
provide interested parties the opportunity
to be included in the fee setting process.
The Departments considered that guid-
ance has historically set the administra-
tive fee amount based on concerns that
the requirement to collect fees sufficient
to fund the Federal IDR process, and the
lead time required to set the fee amount
in notice and comment rulemaking, could
constrain the Departments’ responsive-
ness to program needs and artificially
inflate the administrative fee amount due
to the need to ensure adequate funding of
the process. However, in light of TMA IV,
the Departments are of the view that the
increased transparency and opportunity
for interested parties to provide feedback
on the administrative fee methodology
and amount would outweigh the potential
concern that the administrative fee might
be artificially inflated by the need to make
conservative estimates to set the admin-
istrative fee amount further in advance
through notice and comment rulemaking.
2. Certified IDR Entity Fee Ranges (26
CFR 54.9816-8(e)(2), 29 CFR 2590.716-
8(e)(2), and 45 CFR 149.510(e)(2))
The Departments considered main-
taining the current policy that the allow-
able ranges for certified IDR entity fees
would be set in guidance yearly instead
of through notice and comment rulemak-
ing. The Departments considered whether
continuing to set the certified IDR entity
fee ranges in guidance would preserve
necessary flexibility for the certified IDR
entities to choose their fees within the
allowable ranges and submit those fees for
approval to the Departments, and would
allow the Departments time to review and
approve each certified IDR entity’s fees
and publish them in advance of the year
to which the fees apply. The Departments
balanced several considerations, includ-
ing that certified IDR entities are ulti-
mately able to choose their own fee within
the ranges established in guidance by
the Departments, and that setting the fee
ranges through guidance was intended to
create a competitive market among the
certified IDR entities to keep fees afford-
able, while ensuring that those entities are
able to cover their costs. Setting the allow-
able ranges for certified IDR entity fees
through notice and comment rulemaking
is appropriate because it would increase
transparency and provide an opportunity
for the Departments to consider comments
from interested parties.
F. Paperwork Reduction Act
These proposed rules are not subject
to the requirements of the Paperwork
Reduction Act of 1995,
96
because they do
not contain a collection of information as
95
U.S. Bureau of Labor Statistics (May 1, 2022). May 2022 National Occupational Employment and Wage Estimates. https://www.bls.gov/oes/current/oes_nat.htm.
96
44 U.S.C. 3501 et seq.

November 20, 2023 1278 Bulletin No. 2023–47
defined in 44 U.S.C. 3502(3). Therefore,
clearance by OMB under the Paperwork
Reduction Act of 1995 is not required.
G. Regulatory Flexibility Act
The Regulatory Flexibility Act (RFA)
(5 U.S.C. 601, et seq.) requires agencies
to analyze options for regulatory relief of
small entities and to prepare an initial reg-
ulatory flexibility analysis to describe the
impact of these proposed rules on small
entities, unless the head of the agency can
certify that the rule would not have a sig-
nificant economic impact on a substantial
number of small entities. The RFA gener-
ally defines a “small entity” as (1) a pro-
prietary firm meeting the size standards of
the Small Business Administration (SBA),
(2) a not-for-profit organization that is not
dominant in its field, or (3) a small gov-
ernment jurisdiction with a population of
less than 50,000. States and individuals
are not included in the definition of “small
entity.” The Departments use a change
in revenues of more than 3 to 5 percent
as their measure of significant economic
impact on a substantial number of small
entities. For purposes of the RFA, small
entities include small businesses, non-
profit organizations, and small govern-
mental jurisdictions.
The provisions in these proposed rules
would affect plans (or their TPAs),
97

health insurance issuers offering group or
individual health insurance coverage, and
providers, facilities, and providers of air
ambulance services.
For purposes of analysis under the
RFA,
98
the Departments consider an
employee benefit plan with fewer than
100 participants to be a small entity.
99

The basis of this definition is found in
section 104(a)(2) of ERISA,
100
which per-
mits the Secretary of Labor to prescribe
simplified annual reports for plans that
cover fewer than 100 participants. Under
section 104(a)(3),
101
the Secretary may
also provide for exemptions or simpli-
fied annual reporting and disclosure for
welfare benefit plans. Under the authority
of section 104(a)(3),
102
the Department
of Labor has previously issued simpli-
fied reporting provisions and limited
exemptions from reporting and disclosure
requirements for small plans, including
unfunded or insured welfare plans, which
cover fewer than 100 participants and sat-
isfy certain requirements.
103
While some
large employers have small plans, small
plans are generally maintained by small
employers. Thus, the Departments are of
the view that assessing the impact of these
proposed rules on small plans is an appro-
priate substitute for evaluating the effect
on small entities. The definition of a small
entity considered appropriate for this pur-
pose differs, however, from a definition of
a small business based on size standards
issued by the SBA
104
in accordance with
the Small Business Act.
105
In 2021, there were 1,500 issuers in the
U.S. health insurance market
106
and 205
TPAs.
107
Health insurance issuers are gen-
erally classified under the North American
Industry Classification System (NAICS)
code 524114 (Direct Health and Medical
Insurance Carriers). According to SBA
size standards,
108
entities with average
annual receipts of $47 million or less are
considered small entities for this NAICS
code. The Departments expect that few,
if any, insurance companies underwrit-
ing health insurance policies fall below
these size thresholds. Based on data from
Medical Loss Ratio (MLR) annual report
submissions for the 2021 MLR reporting
year, approximately 87 out of 483 issuers
of health insurance coverage nationwide
had total premium revenue of $47 million
or less.
109
However, it should be noted that
over 77 percent of these small compa-
nies belong to larger holding groups, and
many, if not all, of these small companies,
are likely to have non-health lines of busi-
ness that would result in their revenues
exceeding $47 million. For the purposes
of this analysis, the Departments assume
8.6 percent, or 128 issuers, and 18 TPAs
are considered small entities.
These proposed rules would also
affect health care providers due to the
proposed requirements related to the cer-
tified IDR entity and administrative fees.
The Departments estimate that 140,270
physicians,

on average, bill on an out-of-
network basis. The number of small phy-
sicians is estimated based on the SBA’s
size standards. The size standard applied
for providers is NAICS 62111 (Offices
of Physicians), for which a business with
less than $16 million in receipts is con-
sidered to be small. By this standard, the
Departments estimate that 47.2 percent or
66,207 physicians are considered small
under the SBA’s size standards.
110
These
proposed rules are also expected to affect
non-physician providers who bill on an
out-of-network basis. The Departments
lack data on the number of non-physician
providers who would be impacted.
The Departments do not have the same
level of data for the air ambulance subsec-
tor. In 2020, the total revenue of providers
of air ambulance services was estimated to
be $4.2 billion, with 1,114 air ambulance
97
The Departments expect that most self-insured group health plans will work with a TPA to meet the requirements.
98
5 U.S.C. 601, et seq.
99
The Departments consulted with the Small Business Administration Office of Advocacy in making this determination, as required by 5 U.S.C. 603(c) and 13 CFR 121.903(c) in a memo
dated June 4, 2020.
100
29 U.S.C. 1024(a)(2).
101
29 U.S.C. 1024(a)(3).
102
29 U.S.C. 1024(a)(3).
103
29 CFR 2520.104-20, 2520.104-21, 2520.104-41, 2520.104-46, and 2520.104b-10.
104
13 CFR 121.201 (2011).
105
15 U.S.C. 631 et seq. (2011).
106
Centers for Medicare & Medicaid Services (2022). Medical Loss Ratio Data and System Resources. https://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.
107
Non-issuer TPAs based on data derived from the 2016 benefit year reinsurance program contributions.
108
United States Small Business Administration (March 17, 2023). Table of Size Standards. https://www.sba.gov/document/support--table-size-standards.
109
Centers for Medicare & Medicaid Services (2022). Medical Loss Ratio Data and System Resources. https://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.
110
Based on data from the NAICS Association for NAICS code 62111, the Departments estimate the percent of businesses within the industry of Offices of Physicians with less than $16 mil-
lion in annual sales. United States Census Bureau (May 2021). 2017 SUSB Annual Data Tables by Establishment Industry. https://www.census.gov/data/tables/2017/econ/susb/2017-susb-an-
nual.html.

Bulletin No. 2023–47 1279 November 20, 2023
bases.
111
This results in an industry aver-
age of $3.8 million per air ambulance
base. Accordingly, the Departments are
of the view that most providers of air
ambulance services are likely to be small
entities.
The proposed policies that would result
in an increased burden to small entities are
described below.
The Departments propose to estab-
lish the administrative fee amount in
notice and comment rulemaking, and the
Departments propose that the adminis-
trative fee amount for disputes initiated
on or after of the effective date of these
rules or on January 1, 2024, would be
$150 per party. The total annual burden
associated with this proposal is $45 mil-
lion, split evenly between plans and issu-
ers and providers, facilities, and providers
of air ambulance services ($22.5 million
each). For more details, please refer to the
Regulatory Impact Analysis in these pro-
posed rules.
The Departments propose to estab-
lish the certified IDR entity fee ranges
in notice and comment rulemaking, and
the Departments propose that the ranges
would be $200–$840 for single deter-
minations and $268–$1,173 for batched
determinations, with a $75–$250 tiered
fee range for disputes that contain more
than 25 line items. The total annual bur-
den associated with this proposal is
approximately $9 million, 30 percent
($2.7 million) for providers, facilities, and
providers of air ambulance services
112
and
70 percent ($6.3 million) for plans and
issuers.
113
For more details, please refer to
the Regulatory Impact Analysis in these
proposed rules.
To estimate the proportion of the total
costs that would fall on small entities, the
Departments assume that the proportion
of costs is proportional to the industry
receipts. Applying data from the Census
Bureau of receipts by size for each indus-
try, the Departments estimate that small
issuers would incur 0.2 percent of the total
costs incurred by all issuers and small
providers would incur 42.4 percent of the
total cost by all providers.
114
For the proposal to set the administra-
tive fee amount at $150 per party for dis-
putes initiated on or after the later of the
effective date of these rules or January 1,
2024, the Departments estimate that the
total annual cost for small providers
115

would be $9,540,000.
116
This results in
a per-entity cost for small providers of
$144.09.
117
The Departments estimate that
the total annual cost for small issuers and
TPAs would be $45,000.
118
This results
in a per-entity cost for small issuers and
TPAs of $308.22.
119
For the proposal to set the certified IDR
entity fee ranges at $200–$840 for sin-
gle determinations and $268–$1,173 for
batched determinations, with a $75–$250
tiered fee range for disputes that contain
more than 25 line items, the Departments
estimate that the total annual cost for small
providers
120
would be $1,144,800.
121
This
results in a per-entity cost for small pro-
viders of $17.29.
122
The Departments esti-
mate that the total annual cost for small
issuers and TPAs would be $12,600.
123

This results in a per-entity cost for small
issuers and TPAs of $86.30.
124
Thus, the total estimated annual cost
for small issuers and TPAs is $57,600, and
the total estimated annual cost for small
providers is $10,684,800. The per-entity
annual cost for small issuers and TPAs is
$394.52, and the per-entity annual cost for
small providers is $161.38.
The Departments seek comment on
this analysis and seek information on the
number of small plans (or TPAs), issuers,
or providers that may be affected by the
provisions in these proposed rules.
The number of impacted small health
plans is not significant compared to the
total universe of 1.9 million small health
plans. Assuming that 340,000 disputes
are submitted to the Federal IDR pro-
cess each year, 18 percent of small health
plans would be impacted.
125
The number
of impacted plans and issuers may be
even smaller if some plans and issuers
have multiple disputes that are batched
in the Federal IDR process. By batching
111
ASPE Office of Health Policy (September 10, 2021). Air Ambulance Use and Surprise Billing. https://aspe.hhs.gov/sites/default/files/2021-09/aspe-air-ambulance-ib-09-10-2021.pdf.
112
Historically, less than 1 percent of disputes for emergency and non-emergency services have been submitted by group health plans, health insurance issuers, or FEHB carriers. U.S.
Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of Treasury (n.d.) Initial Report on the Federal Independent Dispute Resolution (IDR) Process,
April 15 – September 30, 2022. https://www.cms.gov/files/document/initial-report-idr-april-15-september-30-2022.pdf.
113
Data from the first full year of Federal IDR process operations show that initiating parties prevail in approximately 70 percent of disputes. See Centers for Medicare & Medicaid Services
(April 27, 2023). Federal Independent Dispute Resolution Process – Status Update. Therefore, as the prevailing party’s certified IDR entity fee is refunded per 26 CFR 54.9816-8T(d)(1)(ii),
29 CFR 2590.716-8(d)(1)(ii), and 45 CFR 149.510(d)(1)(ii), initiating parties only pay the certified IDR entity fee for 30 percent of disputes, while non-initiating parties pay for the other 70
percent. https://www.cms.gov/files/document/federal-idr-processstatus-update-april-2023.pdf. Therefore, as the prevailing party’s certified IDR entity fee is refunded per 26 CFR 54.9816-
8T(d)(1)(ii), 29 CFR 2590.716-8(d)(1)(ii), and 45 CFR 149.510(d)(1)(ii), initiating parties only pay the certified IDR entity fee for 30 percent of disputes, while non-initiating parties pay for
the other 70 percent.
114
United States Census Bureau (March 2020). 2017 SUSB Annual Data Tables by Establishment Industry, Data by Enterprise Receipt Size. https://www.census.gov/data/tables/2020/econ/
susb/2020-susb-annual.html.
115
Historically, less than 1 percent of disputes for emergency and non-emergency services have been submitted by group health plans, health insurance issuers, or FEHB carriers. U.S.
Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of Treasury (n.d.) Initial Report on the Federal Independent Dispute Resolution (IDR) Process,
April 15 – September 30, 2022. https://www.cms.gov/files/document/initial-report-idr-april-15-september-30-2022.pdf.
116
The total annual cost for small providers is estimated as: $22.5 million x 42.4 percent = $9,540,000.
117
The annual per-entity cost is estimated as: $9,540,000 / 66,207 small providers = $144.09.
118
The total annual cost for small issuers and TPAs is estimated as: $22.5 million x 0.2 percent = $45,000.
119
The annual per-entity cost for small issuers and TPAs is estimated as: $45,000 / (128 issuers + 18 TPAs) = $308.22.
120
Historically, less than 1 percent of disputes for emergency and non-emergency services have been submitted by group health plans, health insurance issuers, or FEHB carriers. U.S.
Department of Health and Human Services, U.S. Department of Labor, and U.S. Department of Treasury (n.d.) Initial Report on the Federal Independent Dispute Resolution (IDR) Process,
April 15 – September 30, 2022. https://www.cms.gov/files/document/initial-report-idr-april-15-september-30-2022.pdf.
121
The total annual cost for small providers is estimated as: $2,700,000 x 42.4 percent = $1,144,800.
122
The annual per-entity cost is estimated as: $1,144,800 / 66,207 small providers = $17.29.
123
The total annual cost for small issuers and TPAs is estimated as: $6,300,000 x 0.2 percent = $12,600.
124
The annual per-entity cost for small issuers and TPAs is estimated as: $12,600 / (128 issuers + 18 TPAs) = $86.30.
125
340,000 claims / 1,927,786 ERISA health plans = 18 percent (Source: 2020 Medical Expenditure Panel Survey-Insurance Component).

November 20, 2023 1280 Bulletin No. 2023–47
qualified IDR items and services, there
may be a reduction in the per-service cost
of the Federal IDR process, and poten-
tially the aggregate administrative costs,
because the Federal IDR process is likely
to exhibit at least some economies of
scale.
126

As its measure of significant eco-
nomic impact on a substantial number
of small entities, HHS uses a change
in revenue of more than 3 to 5 percent.
The Departments are of the view that
this threshold will not be reached by the
requirements in these proposed rules,
given that the annual per-entity cost of
$413.70 per small issuer/TPA represents
0.02 percent of the average annual
receipts for a small issuer/TPA and the
annual per-entity cost of $165.23 per
small provider represents 0.01 percent
of the average annual receipts for a small
provider.
127
Therefore, the Secretary has
certified that these proposed rules will
not have a significant economic impact
on a substantial number of small entities.
In addition, section 1102(b) of the
Paperwork Reduction Act requires
the Departments to prepare a regula-
tory impact analysis if a rule may have
a significant impact on the operations
of a substantial number of small rural
hospitals. This analysis must conform
to the provisions of section 603 of the
RFA.
128
For purposes of section 1102(b)
of the Paperwork Reduction Act, the
Departments define a small rural hospi-
tal as a hospital that is located outside
of a metropolitan statistical area and has
fewer than 100 beds. While these pro-
posed rules are not subject to section
1102 of the Paperwork Reduction Act,
the Departments have determined that
these proposed rules will not affect small
rural hospitals. Therefore, the Secretary
has certified that these proposed rules
will not have a significant impact on the
operations of a substantial number of
small rural hospitals.
H. Special Analyses – Department of the
Treasury
Pursuant to the Memorandum
of Agreement, Review of Treasury
Regulations under Executive Order 12866
(June 9, 2023), tax regulatory actions
issued by the IRS are not subject to the
requirements of section 6 of Executive
Order 12866, as amended. Therefore,
a regulatory impact assessment is not
required. Pursuant to section 7805(f) of the
Code,
129
these regulations have been sub-
mitted to the Chief Counsel for Advocacy
of the Small Business Administration
for comment on their impact on small
business.
I. Unfunded Mandates Reform Act
Section 202 of the Unfunded Mandates
Reform Act of 1995 (UMRA)
130
requires
that agencies assess anticipated costs and
benefits and take certain other actions
before issuing a proposed rule or any final
rule for which a general notice of proposed
rulemaking was published that includes
any Federal mandate that may result in
expenditures in any 1 year by State, local,
or tribal governments, in the aggregate, or
by the private sector, of $100 million in
1995 dollars, updated annually for infla-
tion. That threshold is approximately $177
million in 2023. As discussed earlier in the
RIA, plans, issuers, TPAs, and providers,
facilities, and providers of air ambulance
services would incur costs to comply with
the provisions of these proposed rules.
The Departments estimate the combined
impact on State, local, or tribal govern-
ments and the private sector would not be
above the threshold.
J. Federalism
Executive Order 13132 outlines the
fundamental principles of federalism.
It requires adherence to specific criteria
by Federal agencies in formulating and
implementing policies that have “substan-
tial direct effects” on the States, the rela-
tionship between the national government
and States, or on the distribution of power
and responsibilities among the various
levels of government. Federal agencies
issuing regulations that have these feder-
alism implications must consult with State
and local officials and describe the extent
of their consultation and the nature of the
concerns of State and local officials in the
preamble to these proposed rules.
The Departments do not anticipate that
these proposed rules would have federal-
ism implications or limit the policy-mak-
ing discretion of the States in compliance
with the requirement of Executive Order
13132.
State and local government health
plans may be subject to the Federal IDR
process where a specified State law or All-
Payer Model Agreement does not apply.
The No Surprises Act authorizes States to
enforce the new requirements, including
those related to balance billing, for issu-
ers, providers, facilities, and providers of
air ambulance services, with HHS enforc-
ing only in cases where the State has noti-
fied HHS that the State does not have the
authority to enforce or is otherwise not
enforcing, or HHS has made a determina-
tion that a State has failed to substantially
enforce the requirements. However, in the
Departments’ view, the federalism impli-
cations of these proposed rules are sub-
stantially mitigated because some States
have their own process for determining
the total amount payable under a plan or
coverage for out-of-network emergency
services and to out-of-network providers
for patient visits to in-network facilities
for non-emergency services. Where a
State has a specified State law, the State
law, rather than the Federal IDR process,
would apply.
In compliance with the requirement
of Executive Order 13132 that agencies
126
Fielder, M., Adler, L., Ippolito, B. (March 16, 2021). Recommendations for Implementing the No Surprises Act. U.S.C.-Brookings Schaeffer on Health Policy. https://www.brookings.edu/
blog/usc-brookings-schaeffer-on-health-policy/2021/03/16/recommendations-for-implementing-the-no-surprises-act/.
127
United States Census Bureau (March 2020). 2017 SUSB Annual Data Tables by Establishment Industry, Data by Enterprise Receipt Size. https://www.census.gov/data/tables/2020/econ/
susb/2020-susb-annual.html.
128
5 U.S.C. 603.
129
26 U.S.C. 7805(f).
130
2 U.S.C. 1511.

Bulletin No. 2023–47 1281 November 20, 2023
examine closely any policies that may
have federalism implications or limit the
policy making discretion of the States, the
Departments have engaged in efforts to
consult with and work cooperatively with
affected States, including participating in
conference calls with and attending con-
ferences of the National Association of
Insurance Commissioners and consulting
with State insurance officials on an indi-
vidual basis.
While developing these rules, the
Departments attempted to balance the
States’ interests in regulating health insur-
ance issuers with the need to ensure mar-
ket stability. By doing so, the Departments
complied with the requirements of
Executive Order 13132.
Douglas W. O’Donnell,
Deputy Commissioner for
Services and Enforcement,
Internal Revenue Service
Lisa M. Gomez
Assistant Secretary,
Employee Benefits Security
Administration,
Department of Labor
Xavier Becerra,
Secretary,
Department of Health and
Human Services.
List of Subjects
26 CFR Part 54
Excise taxes, Pensions, Reporting and
recordkeeping requirements.
29 CFR Part 2590
Child support, Employee benefit plans,
Health care, Health insurance, Infants
and children, Maternal and child health,
Penalties, Pensions, Privacy, Reporting
and recordkeeping requirements.
45 CFR Part 149
Administrative practice and procedure,
Health care, Health insurance, Insurance
companies, Penalties, Reporting, and
recordkeeping requirements.
DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
Accordingly, the Department of the
Treasury and the IRS proposes to amend
26 CFR part 54 as follows:
PART 54 – PENSION EXCISE TAXES
1. The authority citation for part 54
is amended by adding an entry for §
54.9816-8 in numerical order to read in
part as follows:
Authority: 26 U.S.C. 7805 * * *
* * * * *
Section 54.9816-8 also issued under 26
U.S.C. 9816.
* * * * *
2. Section 54.9816-8 is amended by
revising paragraphs (a) through (e) and
the headings for paragraphs (f) and (g) to
read as follows:
§ 54.9816-8 Independent dispute
resolution process.
(a) Scope and definitions. For further
guidance, see § 54.9816-8T(a).
(b) Determination of payment amount
through open negotiation and initiation of
the Federal IDR process. For further guid-
ance, see § 54.9816-8T(b).
(c) Federal IDR process following
initiation. For further guidance, see §
54.9816-8T(c).
(d) Costs of IDR process. (1) Certified
IDR entity fee. For further guidance, see
§ 54.9816-8T(d)(1).
(2) Administrative fee. (i) For further
guidance, see § 54.9816-8T(d)(2)(i).
(ii) The administrative fee amount will
be established through notice and com-
ment rulemaking in a manner such that
the total administrative fees paid for a
year are estimated to be equal to the pro-
jected amount of expenditures made by
the Secretaries of the Treasury, Labor, and
Health and Human Services for the year in
carrying out the Federal IDR process. For
disputes initiated on or after the later of
the effective date of Federal Independent
Dispute Resolution (IDR) Process
Administrative Fee and Certified IDR
Entity Fee Ranges final rules or January
1, 2024, the administrative fee amount is
$150 per party per dispute and will remain
in effect until changed by subsequent
rulemaking.
(3) Severability. (i) Any provision of
this paragraph (d) or paragraphs (e)(2)
(vii) through (ix) of this section held to
be invalid or unenforceable as applied to
any person or circumstance shall be con-
strued so as to continue to give the maxi-
mum effect to the provision permitted by
law, including as applied to persons not
similarly situated or to dissimilar circum-
stances, unless such holding is that the
provision of these paragraphs is invalid
and unenforceable in all circumstances,
in which event the provision shall be sev-
erable from the remainder of these para-
graphs and shall not affect the remainder
thereof.
(ii) The provisions in paragraphs (d)
and (e)(2)(vii) through (ix) of this section
are intended to be severable from each
other.
(e) Certification of IDR entity — (1)
In general. For further guidance see §
54.9816-8T(e)(1).
(2) Requirements. (i) through (vi). For
further guidance, see § 54.8616-8T(e)(2)
(i) through (vi).
(vii) Provide, on an annual basis, a
fixed fee for single determinations and
separate fixed fees for batched determi-
nations, as well as additional fixed tiered
fees for batched disputes, if applicable,
within the upper and lower limits for each,
as established by the Secretary in notice
and comment rulemaking. The certi-
fied IDR entity fee ranges established by
the Secretary in rulemaking will remain
in effect until changed by subsequent
rulemaking. The certified IDR entity may
not charge a fee outside the limits set
forth in rulemaking unless the certified
IDR entity or IDR entity seeking certifi-
cation receives advance written approval
from the Secretary to charge a fixed fee
beyond the upper or lower limits. The
certified IDR entity or IDR entity seek-
ing certification may also seek advance
written approval from the Secretary to
update its fees more frequently than once
annually. If a certified IDR entity or IDR
entity seeking certification submits to the
Secretary a request to charge a fixed fee
beyond the upper or lower limits for fees
as set forth in rulemaking, the Secretary

November 20, 2023 1282 Bulletin No. 2023–47
will use their discretion to determine if the
information submitted by a certified IDR
entity or IDR entity seeking certification
demonstrates that the proposed change to
the certified IDR entity fee would ensure
the certified IDR entity’s financial viability
and would not impose on parties an undue
barrier to accessing the Federal IDR pro-
cess. In order for the certified IDR entity
to receive the Secretary’s written approval
to charge a fee beyond the upper or lower
limits for fees as set forth in rulemaking,
or to modify the fixed fees more than once
annually, it must satisfy the conditions in
both paragraphs (e)(2)(vii)(A) and (B) of
this section, as follows:
(A) Submit, in writing, a proposal to
the Secretary that includes:
(1) If requesting to charge a fixed fee
beyond the upper or lower limits for fees
as set forth in rulemaking:
(i) The alternative fixed fee the certi-
fied IDR entity or IDR entity seeking cer-
tification believes is appropriate for the
certified IDR entity or IDR entity seeking
certification to charge;
(ii) A description of the circumstances
that require the alternative fee; and
(iii) A description that reasonably
explains how the alternative fixed fee will
be used to mitigate the effects of those cir-
cumstances; or
(2) If requesting to modify the fixed fee
more than once annually:
(i) The fixed fee the certified IDR entity
is seeking to charge;
(ii) A description of the circumstances
that require a change to its fixed fee; and
(iii) A detailed description that reason-
ably explains how the change to its fixed
fee will be used to mitigate the effects of
those circumstances.
(B) Receive from the Secretary, the
Secretary of Health and Human Services,
and the Secretary of Labor written
approval to charge the fee documented in
the certified IDR entity’s or the IDR entity
seeking certification’s written proposal.
(viii) For disputes initiated on or after
the later of the effective date of Federal
Independent Dispute Resolution (IDR)
Process Administrative Fee and Certified
IDR Entity Fee Ranges final rules or
January 1, 2024, certified IDR entities are
permitted to charge a fixed certified IDR
entity fee for single determinations within
the range of $200 to $840, unless a fee
not within that range is approved by the
Secretary pursuant to paragraphs (e)(2)
(vii)(A) and (B) of this section. The range
for the certified IDR entity fee for single
determinations will remain in effect until
changed by subsequent rulemaking.
(ix) For disputes initiated on or after
the later of the effective date of Federal
Independent Dispute Resolution (IDR)
Process Administrative Fee and Certified
IDR Entity Fee Ranges final rules or
January 1, 2024, certified IDR entities
are permitted to charge a fixed certified
IDR entity fee for batched determinations
within the range of $268 to $1,173, unless
a fee not within that range is approved by
the Secretary pursuant to paragraphs (e)
(2)(vii)(A) and (B) of this section. As part
of the batched determination fee, certified
IDR entities are permitted to charge an
additional fixed tiered fee within the range
of $75 to $250 for every additional 25 line
items within a batched dispute, beginning
with the 26th line item. The ranges for
the certified IDR entity fees for batched
determinations will remain in effect until
changed by subsequent rulemaking.
(x) through (xiii). For further guidance,
see § 54.9816-8T(e)(2)(x) through (xiii).
(f) Reporting of information relating to
the Federal IDR process. * * *
(g) Extension of time periods for exten-
uating circumstances. * * *
* * * * *
3. Section 54.9816-8T is amended by:
a. Revising paragraph (d)(2)(ii);
b. Adding paragraph (d)(3);
c. Revising paragraph (e)(2)(vii)
d. Redesignating paragraphs (e)(2)(viii)
through (xi) as paragraphs (e)(2)(x)
through (xiii);
e. Adding new paragraphs (e)(2)(viii)
and (ix).
The revisions and additions read as
follows:
§ 54.9816-8T Independent dispute
resolution process (temporary).
* * * * *
(d) * * *
(2) * * *
(ii) For further guidance, see § 54.9816-
8(d)(2)(ii).
(3) Severability. For further guidance,
see § 54.9816-8(d)(3).
(e) * * *
(2) * * *
(vii) and (ix). For further guidance, see
§ 54.9816-8(e)(2)(vii) and (ix).
* * * * *
DEPARTMENT OF LABOR
Employee Benefits Security
Administration
29 CFR Chapter XXV
For the reasons stated in the pream-
ble, the Department of Labor proposes
to amend 29 CFR part 2590 as set forth
below:
PART 2590—RULES AND
REGULATIONS FOR GROUP
HEALTH PLANS
4. The authority citation for part 2590
continues to read as follows:
Authority: 29 U.S.C. 1027, 1059,
1135, 1161-1168, 1169, 1181-1183, 1181
note, 1185, 1185a, 1185b, 1191, 1191a,
1191b, and 1191c; sec. 101(g), Pub. L.
104-191, 110 Stat. 1936; sec. 401(b),
Pub. L. 105-200, 112 Stat. 645 (42 U.S.C.
651 note); sec. 512(d), Pub. L. 110-343,
122 Stat. 3881; sec. 1001, 1201, and
1562(e), Pub. L. 111-148, 124 Stat. 119,
as amended by Pub. L. 111-152, 124 Stat.
1029; Division M, Pub. L. 113-235, 128
Stat. 2130; Secretary of Labor’s Order
1-2011, 77 FR 1088 (Jan. 9, 2012).
5. Section 2590.716-8 is amended by:
a. Revising paragraph (d)(2)(ii);
b. Adding paragraph (d)(3);
c. Revising paragraph (e)(2)(vii);
d. Redesignating paragraphs (e)(2)(viii)
through (xi) as paragraphs (e)(2)(x)
through (xiii); and
e. Adding new paragraphs (e)(2)(viii)
and (ix).
The revisions and additions read as
follows:
§ 2590.716-8 Independent dispute
resolution process.
* * * * *
(d) * * *
(2) * * *
(ii) The administrative fee amount will
be established through notice and comment
rulemaking in a manner such that the total

Bulletin No. 2023–47 1283 November 20, 2023
administrative fees paid for a year are esti-
mated to be equal to the projected amount
of expenditures made by the Secretaries
of the Treasury, Labor, and Health and
Human Services for the year in carrying
out the Federal IDR process. For disputes
initiated on or after the later of the effec-
tive date of Federal Independent Dispute
Resolution (IDR) Process Administrative
Fee and Certified IDR Entity Fee Ranges
final rules or January 1, 2024, the admin-
istrative fee amount is $150 per party per
dispute, which will remain in effect until
changed by subsequent rulemaking.
(3) Severability. (i) Any provision of
this paragraph (d) or paragraphs (e)(2)
(vii) through (ix) of this section held to
be invalid or unenforceable as applied to
any person or circumstance shall be con-
strued so as to continue to give the maxi-
mum effect to the provision permitted by
law, including as applied to persons not
similarly situated or to dissimilar circum-
stances, unless such holding is that the
provision of these paragraphs is invalid
and unenforceable in all circumstances,
in which event the provision shall be sev-
erable from the remainder of these para-
graphs and shall not affect the remainder
thereof.
(ii) The provisions in paragraphs (d)
(2) and (e)(2)(vii), (viii), and (ix) of this
section are intended to be severable from
each other.
(e) * * *
(2) * * *
(vii) Provide, on an annual basis, a
fixed fee for single determinations and
separate fixed fees for batched determi-
nations, as well as additional fixed tiered
fees for batched disputes, if applicable,
within the upper and lower limits for each,
as established by the Secretary in notice
and comment rulemaking. The certi-
fied IDR entity fee ranges established by
the Secretary in rulemaking will remain
in effect until changed by subsequent
rulemaking. The certified IDR entity may
not charge a fee outside the limits set forth
in rulemaking unless the certified IDR
entity or IDR entity seeking certification
receives advance written approval from
the Secretary to charge a fixed fee beyond
the upper or lower limits. The certified
IDR entity or IDR entity seeking certi-
fication may also seek advance written
approval from the Secretary to update its
fees more frequently than once annually. If
a certified IDR entity or IDR entity seek-
ing certification submits to the Secretary
a request to charge a fixed fee beyond the
upper or lower limited for fees set forth
in rulemaking, the Secretary will use their
discretion to determine if the information
submitted by the certified IDR entity or
entity seeking certification demonstrates
that the proposed change to the certified
IDR entity fee would ensure the certi-
fied IDR entity’s financial viability and
would not impose on parties an undue
barrier accessing the Federal IDR pro-
cess. In order for the certified IDR entity
to receive the Secretary’s written approval
to charge a fee beyond the upper or lower
limits for fees as set forth in rulemaking,
or to modify the fixed fees more than once
annually, it must satisfy the conditions in
both paragraphs (e)(2)(vii)(A) and (B) of
this section, as follows:
(A) Submit, in writing, a proposal to
the Secretary that includes:
(1) If requesting to charge a fixed fee
beyond the upper or lower limits for fees
as set forth in rulemaking:
(i) The alternative fixed fee the certi-
fied IDR entity or IDR entity seeking cer-
tification believes is appropriate for the
certified IDR entity or IDR entity seeking
certification to charge;
(ii) A description of the circumstances
that require the alternative fee; and
(iii) A description that reasonably
explains how the alternative fixed fee will
be used to mitigate the effects of those cir-
cumstances; or
(2) If requesting to modify the fixed fee
more than once annually:
(i) The fixed fee the certified IDR entity
is seeking to charge;
(ii) A description of the circumstances
that require a change to its fixed fee; and
(iii) A detailed description that reason-
ably explains how the change to its fixed
fee will be used to mitigate the effects of
those circumstances.
(B) Receive from the Secretary,
the Secretary of the Treasury, and the
Secretary of Health and Human Services,
written approval to charge the fee docu-
mented in the certified IDR entity’s or the
IDR entity seeking certification’s written
proposal.
(viii) For disputes initiated on or after
the later of the effective date of Federal
Independent Dispute Resolution (IDR)
Process Administrative Fee and Certified
IDR Entity Fee Ranges final rules or
January 1, 2024, certified IDR entities are
permitted to charge a fixed certified IDR
entity fee for single determinations within
the range of $200 to $840, unless a fee
not within that range is approved by the
Secretary pursuant to paragraphs (e)(2)
(vii)(A) and (B) of this section. The range
for the certified IDR entity fee for single
determinations will remain in effect until
changed by subsequent rulemaking.
(ix) For disputes initiated on or after
the later of the effective date of Federal
Independent Dispute Resolution (IDR)
Process Administrative Fee and Certified
IDR Entity Fee Ranges final rules or
January 1, 2024, certified IDR entities
are permitted to charge a fixed certified
IDR entity fee for batched determina-
tions within the range of $268 to $1,173,
unless a fee not within that range is
approved by the Secretary pursuant to
paragraphs (e)(2)(vii)(A) and (B) of this
section. As part of the batched determi-
nation fee, certified IDR entities are per-
mitted to charge an additional fixed tiered
fee within the range of $75 to $250 for
every additional 25 line items within a
batched dispute, beginning with the 26th
line item. The ranges for the certified
IDR entity fees for batched determina-
tions will remain in effect until changed
by subsequent rulemaking.
* * * * *
For the reasons stated in the pream-
ble, the Department of Health and Human
Services proposes to amend 45 CFR part
149 as set forth below:
PART 149—SURPRISE BILLING
AND TRANSPARENCY
REQUIREMENTS
6. The authority citation for part 149
continues to read as follows:
Authority: 42 U.S.C. 300gg-92
and 300gg-111 through 300gg-139, as
amended.
7. Section 149.510 is amended by:
a. Revising paragraph (d)(2)(ii);
b. Adding paragraph (d)(3);
c. Revising paragraph (e)(2)(vii);
d. Redesignating paragraphs (e)(2)(viii)
through (xi) as paragraphs (e)(2)(x)
through (xiii); and

November 20, 2023 1284 Bulletin No. 2023–47
e. Adding new paragraphs (e)(2)(viii)
and (ix).
The revisions and additions read as
follows:
§ 149.510 Independent dispute
resolution process.
* * * * *
(d) * * *
(2) * * *
(ii) The administrative fee amount will
be established through notice and comment
rulemaking in a manner such that the total
administrative fees paid for a year are esti-
mated to be equal to the projected amount
of expenditures made by the Secretaries
of the Treasury, Labor, and Health and
Human Services for the year in carrying
out the Federal IDR process. For disputes
initiated on or after the later of the effec-
tive date of Federal Independent Dispute
Resolution (IDR) Process Administrative
Fee and Certified IDR Entity Fee Ranges
final rules or January 1, 2024, the admin-
istrative fee amount is $150 per party per
dispute, which will remain in effect until
changed by subsequent rulemaking.
(3) Severability. (i) Any provision of
this paragraph (d) or paragraphs (e)(2)
(vii) through (ix) of this section held to
be invalid or unenforceable as applied to
any person or circumstance shall be con-
strued so as to continue to give the maxi-
mum effect to the provision permitted by
law, including as applied to persons not
similarly situated or to dissimilar circum-
stances, unless such holding is that the
provision of these paragraphs is invalid
and unenforceable in all circumstances,
in which event the provision shall be sev-
erable from the remainder of these para-
graphs and shall not affect the remainder
thereof.
(ii) The provisions in this paragraph (d)
and paragraphs (e)(2)(vii) through (ix) of
this section are intended to be severable
from each other.
(e) * * *
(2) * * *
(vii) Provide, on an annual basis, a
fixed fee for single determinations and
a separate fixed fee for batched deter-
minations, as well as an additional fixed
tiered fee for batched disputes, if appli-
cable, within the upper and lower limits
for each, as established by the Secretary in
notice and comment rulemaking. The cer-
tified IDR entity fee ranges established by
the Secretary in rulemaking will remain
in effect until changed by subsequent
rulemaking. The certified IDR entity may
not charge a fee outside the limits set
forth in rulemaking unless the certified
IDR entity or IDR entity seeking certifi-
cation receives advance written approval
from the Secretary to charge a fixed fee
beyond the upper or lower limits. The
certified IDR entity or IDR entity seek-
ing certification may also seek advance
written approval from the Secretary to
update its fees more frequently than once
annually. If a certified IDR entity or IDR
entity seeking certification submits to the
Secretary a request to charge a fixed fee
beyond the upper or lower limits for fees
as set forth in rulemaking, the Secretary
will use their discretion to determine if the
information submitted by a certified IDR
entity or IDR entity seeking certification
demonstrates that the proposed change to
the certified IDR entity fee would ensure
the certified IDR entity’s financial viability
and would not impose on parties an undue
barrier to accessing the Federal IDR pro-
cess. In order for the certified IDR entity
to receive the Secretary’s written approval
to charge a fee beyond the upper or lower
limits for fees as set forth in rulemaking,
or to modify the fixed fees more than once
annually, it must satisfy the conditions in
both paragraphs (e)(2)(vii)(A) and (B) of
this section, as follows:
(A) Submit, in writing, a proposal to
the Secretary that includes:
(1) If requesting to charge a fixed fee
beyond the upper or lower limits for fees
as set forth in rulemaking:
(i) The alternative fixed fee the certi-
fied IDR entity or IDR entity seeking cer-
tification believes is appropriate for the
certified IDR entity or IDR entity seeking
certification to charge;
(ii) A description of the circumstances
that require the alternative fee; and
(iii) A description that reasonably
explains how the alternative fixed fee will
be used to mitigate the effects of those cir-
cumstances; or
(2) If requesting to modify the fixed fee
more than once annually:
(i) The fixed fee the certified IDR entity
is seeking to charge;
(ii) A description of the circumstances
that require a change to its fixed fee; and
(iii) A detailed description that reason-
ably explains how the change to its fixed
fee will be used to mitigate the effects of
those circumstances.
(B) Receive from the Secretary,
the Secretary of the Treasury, and the
Secretary of Labor, written approval to
charge the fee documented in the certified
IDR entity’s or the IDR entity seeking cer-
tification’s written proposal.
(viii) For disputes initiated on or after
the later of the effective date of Federal
Independent Dispute Resolution (IDR)
Process Administrative Fee and Certified
IDR Entity Fee Ranges final rules or
January 1, 2024, certified IDR entities are
permitted to charge a fixed certified IDR
entity fee for single determinations within
the range of $200 to $840, unless a fee
not within that range is approved by the
Secretary, pursuant to paragraphs (e)(2)
(vii)(A) and (B) of this section. The range
for the certified IDR entity fee for single
determinations will remain in effect until
changed by subsequent rulemaking.
(ix) For disputes initiated on or after
the later of the effective date of Federal
Independent Dispute Resolution (IDR)
Process Administrative Fee and Certified
IDR Entity Fee Ranges final rules or
January 1, 2024, certified IDR entities
are permitted to charge a fixed certified
IDR entity fee for batched determinations
within the range of $268 to $1,173, unless
a fee not within that range is approved by
the Secretary pursuant to paragraphs (e)
(2)(vii)(A) and (B) of this section. As part
of the batched determination fee, certified
IDR entities are permitted to charge an
additional fixed tiered fee within the range
of $75 to $250 for every additional 25 line
items within a batched dispute, beginning
with the 26th line item. The ranges for
the certified IDR entity fees for batched
determinations will remain in effect until
changed by subsequent rulemaking.
* * * * *
(Filed by the Office of the Federal Register
September 21, 2023, 4:15 p.m., and published in the
issue of the Federal Register for September 26, 2023,
88 FR 65888)

Bulletin No. 2023–47 1285 November 20, 2023
Notice of Proposed
Rulemaking
Requirements Related to
the Mental Health Parity
and Addiction Equity Act;
Extension of Comment
Period
REG-120727-21
DEPARTMENT OF THE
TREASURY
Internal Revenue Service
26 CFR Part 54
DEPARTMENT OF LABOR
Employee Benefits Security
Administration
29 CFR Part 2590
DEPARTMENT OF HEALTH
AND HUMAN SERVICES
45 CFR Parts 146 and 147
AGENCY: Internal Revenue Service,
Department of the Treasury; Employee
Benefits Security Administration,
Department of Labor; Centers for Medicare
& Medicaid Services, Department of
Health and Human Services.
ACTION: Proposed rules; extension of
comment period.
SUMMARY: This document extends
the comment period for the proposed
rules entitled “Requirements Related to
the Mental Health Parity and Addiction
Equity Act” that were published in the
August 3, 2023, issue of the Federal
Register. The comment period for the
proposed rules, which had been scheduled
to close on October 2, 2023, is extended
15 days to October 17, 2023.
DATES: The comment period for the pro-
posed rules published August 3, 2023, at
88 FR 51552, is extended. To be assured
consideration, comments must be received
at one of the addresses provided below, no
later than October 17, 2023.
ADDRESSES: Written comments may
be submitted to the addresses specified
below. Any comment that is submit-
ted will be shared with the Department
of the Treasury (Treasury Department),
Internal Revenue Service (IRS), and
the Department of Health and Human
Services (HHS). Please do not submit
duplicates.
Comments will be made available to
the public. Warning: Do not include any
personally identifiable information (such
as name, address, or other contact infor-
mation) or confidential business infor-
mation that you do not want publicly
disclosed. All comments are posted on
the internet exactly as received and can be
retrieved by most internet search engines.
No deletions, modifications, or redactions
will be made to the comments received,
as they are public records. Comments may
be submitted anonymously.
In commenting, please refer to file
code 1210-AC11. Because of staff and
resource limitations, the Department of
Labor (DOL) cannot accept comments by
facsimile (FAX) transmission.
Comments, including mass comment
submissions, must be submitted in one
of the following two ways (please choose
only one of the ways listed):
1. Electronically. You may submit elec-
tronic comments on this regulation to
https://www.regulations.gov. Follow
the “Submit a comment” instructions.
2. By mail. You may mail written com-
ments to the following address ONLY:
Office of Health Plan Standards and
Compliance Assistance, Employee
Benefits Security Administration,
Room N-5653, U.S. Department of
Labor, 200 Constitution Avenue,
NW., Washington, DC 20210,
Attention: 1210-AC11.
Please allow sufficient time for mailed
comments to be received before the close
of the comment period.
FOR FURTHER INFORMATION,
CONTACT: Shira McKinlay, Internal
Revenue Service, Department of the
Treasury, at 202-317-5500; Beth Baum or
David Sydlik, Employee Benefits Security
Administration, Department of Labor, at
202-693-8335; David Mlawsky, Centers
for Medicare & Medicaid Services,
Department of Health and Human
Services, at 410-786-6851.
Customer Service Information:
Individuals interested in obtaining
information from DOL concerning private
employment-based health coverage laws
may call the Employee Benefits Security
Administration (EBSA) Toll-Free Hotline
at 1-866-444-EBSA (3272) or visit the
DOL’s website (www.dol.gov/agencies/
ebsa).
In addition, information from HHS on
private health insurance coverage and cov-
erage provided by self-funded, non-Fed-
eral governmental group health plans can
be found on the Centers for Medicare
& Medicaid Services (CMS) website
(www.cms.gov/cciio), and information on
health care reform can be found at www.
Healthcare.gov or https://www.hhs.gov/
healthcare/index.html. In addition, infor-
mation about mental and behavioral health
and addiction is available at https://www.
samhsa.gov/mental-health and https://
www.samhsa.gov/find-support.
SUPPLEMENTARY INFORMATION:
In the proposed rules, “Requirements
Related to the Mental Health Parity and
Addiction Equity Act,” released by the
Departments of the Treasury, Labor, and
HHS (collectively, the Departments)
on July 25, 2023, and published in the
Federal Register on August 3, 2023 (88
FR 51552), the Departments solicited
public comments on proposals to amend
the regulations that implement the Paul
Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of
2008 (MHPAEA) and establish new reg-
ulations for the nonquantitative treatment
limitation (NQTL) comparative analyses
required under MHPAEA, as amended
by the Consolidated Appropriations Act,
2021. The proposed rules would amend
the existing NQTL standard to prevent
group health plans and health insurance
issuers offering group or individual health
insurance coverage that provides both
medical and surgical benefits and mental
health or substance use disorder benefits
from using NQTLs to place greater limits
on access to mental health and substance
use disorder benefits as compared to

November 20, 2023 1286 Bulletin No. 2023–47
medical/surgical benefits. As part of these
proposed changes, the proposed rules
would require plans and issuers to collect
and evaluate relevant data in a manner
reasonably designed to assess the impact
of NQTLs on access to mental health and
substance use disorder benefits and medi-
cal/surgical benefits, and propose a special
rule for NQTLs related to network com-
position. The proposed rules also would
amend existing examples and add new
examples on the application of the rules
for NQTLs to clarify and illustrate the
protections of MHPAEA. In addition, the
proposed rules would set forth the con-
tent requirements for NQTL comparative
analyses and specify how plans and issu-
ers must make these comparative analyses
available to the Departments, as well as to
an applicable State authority, and partic-
ipants, beneficiaries, and enrollees. The
Departments also solicited comments on
whether there are ways to improve the
coverage of mental health and substance
use disorder benefits through other provi-
sions of Federal law. Additionally, HHS
proposed amendments to implement the
sunset provision for self-funded, non-Fed-
eral governmental plan elections to opt out
of compliance with MHPAEA, as adopted
in the Consolidated Appropriations Act,
2023. The comment period for the pro-
posed rules was scheduled to close on
October 2, 2023.
Additionally, on July 25, 2023, DOL, in
collaboration with HHS and the Treasury
Department, issued Technical Release
2023-01P.
1
The Technical Release sets
out principles and seeks public comment
to inform future guidance with respect to
the application of the proposed data col-
lection and evaluation requirements to
NQTLs related to network composition
and a potential time-limited enforcement
safe harbor for plans and issuers that
include data in their comparative analy-
ses that demonstrates they meet or exceed
all of the thresholds identified in future
guidance with respect to NQTLs related
to network composition. Specifically, the
Technical Release solicits feedback on the
type, form, and manner for the data that
plans and issuers would be required to
include, along with other relevant data as
appropriate, as part of their comparative
analyses for NQTLs related to network
composition which must be submitted
to the Departments upon request. The
Technical Release also solicits feedback
on how to define certain thresholds for
required data and a potential time-lim-
ited enforcement safe harbor to be spec-
ified in future guidance that, if satisfied,
would demonstrate to the Departments
that a plan or coverage provides compa-
rable access to in-network providers for
mental health and substance use disorder
benefits as compared to medical/surgical
benefits. In turn, if all of these safe har-
bor thresholds are met or exceeded, the
plan or issuer would not be subject to
Federal enforcement under MHPAEA
with respect to NQTLs related to network
composition for a specified period of time.
Comments on Technical Release 2023-
01P should be sent via email to mhpaea.
rfc.ebsa@dol.gov. All comments on
Technical Release 2023-01P submitted to
DOL will be shared with HHS, the IRS,
and the Treasury Department and posted
on DOL’s Employee Benefits Security
Administration’s (EBSA) website. The
comment period for Technical Release
2023-01P was scheduled to close on
October 2, 2023.
Since the publication of the proposed
rules in the Federal Register and the
release of Technical Release 2023-01P
on EBSA’s website, there has been con-
siderable interest expressed in these doc-
uments, and some interested parties have
requested additional time to review and
submit comments. The Departments value
public feedback as they consider whether
and how to issue final rules and future
guidance. In response to these requests,
the Departments are extending the period
for submitting comments on the proposed
rules to October 17, 2023. Additionally,
to ensure consistency with the comment
period for the proposed rules, DOL is
simultaneously extending the comment
period for Technical Release 2023-01P to
October 17, 2023. To be assured consid-
eration, comments on the proposed rules
and Technical Release must be received
no later than October 17, 2023.
Dated: September 22, 2023.
Douglas W. O’Donnell,
Deputy Commissioner for Services and
Enforcement,
Internal Revenue Service.
Lisa M. Gomez,
Assistant Secretary, Employee Benefits
Security Administration, Department of
Labor.
Xavier Becerra,
Secretary,
Department of Health and Human
Services.
(Filed by the Office of the Federal Register
September 27, 2023, 8:45 a.m., and published in the
issue of the Federal Register for September 28, 2023,
88 FR 66728)
1
Department of Labor, Employee Benefits Security Administration, Technical Release 2023-01P: Request for Comment on Proposed Relevant Data Requirements for Nonquantitative
Treatment Limitations (NQTLs) Related to Network Composition and Enforcement Safe Harbor for Group Health Plans and Health Insurance Issuers Subject to the Mental Health Parity and
Addiction Equity Act (July 25, 2023), available at https://www.dol.gov/agencies/ebsa/employers-and-advisers/guidance/technical-releases/23-01.

Bulletin No. 2023–47 i November 20, 2023
Definition of Terms
Revenue rulings and revenue procedures
(hereinafter referred to as “rulings”) that
have an effect on previous rulings use the
following defined terms to describe the
effect:
Amplified describes a situation where
no change is being made in a prior pub-
lished position, but the prior position is
being extended to apply to a variation of
the fact situation set forth therein. Thus, if
an earlier ruling held that a principle ap-
plied to A, and the new ruling holds that
the same principle also applies to B, the
earlier ruling is amplified. (Compare with
modified, below).
Clarified is used in those instances
where the language in a prior ruling is be-
ing made clear because the language has
caused, or may cause, some confusion. It
is not used where a position in a prior rul-
ing is being changed.
Distinguished describes a situation
where a ruling mentions a previously pub-
lished ruling and points out an essential
difference between them.
Modified is used where the substance
of a previously published position is being
changed. Thus, if a prior ruling held that a
principle applied to A but not to B, and the
new ruling holds that it applies to both A
and B, the prior ruling is modified because
it corrects a published position. (Compare
with amplified and clarified, above).
Obsoleted describes a previously pub-
lished ruling that is not considered deter-
minative with respect to future transactions.
This term is most commonly used in a ruling
that lists previously published rulings that
are obsoleted because of changes in laws or
regulations. A ruling may also be obsoleted
because the substance has been included in
regulations subsequently adopted.
Revoked describes situations where the
position in the previously published ruling
is not correct and the correct position is
being stated in a new ruling.
Superseded describes a situation where
the new ruling does nothing more than
restate the substance and situation of a
previously published ruling (or rulings).
Thus, the term is used to republish under
the 1986 Code and regulations the same
position published under the 1939 Code
and regulations. The term is also used
when it is desired to republish in a single
ruling a series of situations, names, etc.,
that were previously published over a
period of time in separate rulings. If the
new ruling does more than restate the sub-
stance of a prior ruling, a combination of
terms is used. For example, modified and
superseded describes a situation where the
substance of a previously published ruling
is being changed in part and is continued
without change in part and it is desired to
restate the valid portion of the previous-
ly published ruling in a new ruling that is
self contained. In this case, the previously
published ruling is first modified and then,
as modified, is superseded.
Supplemented is used in situations in
which a list, such as a list of the names of
countries, is published in a ruling and that
list is expanded by adding further names
in subsequent rulings. After the original
ruling has been supplemented several
times, a new ruling may be published that
includes the list in the original ruling and
the additions, and supersedes all prior rul-
ings in the series.
Suspended is used in rare situations
to show that the previous published rul-
ings will not be applied pending some
future action such as the issuance of new
or amended regulations, the outcome of
cases in litigation, or the outcome of a
Service study.
Abbreviations
The following abbreviations in current
use and formerly used will appear in
material published in the Bulletin.
A—Individual.
Acq.—Acquiescence.
B—Individual.
BE—Beneficiary.
BK—Bank.
B.T.A.—Board of Tax Appeals.
C—Individual.
C.B.—Cumulative Bulletin.
CFR—Code of Federal Regulations.
CI—City.
COOP—Cooperative.
Ct.D.—Court Decision.
CY—County.
D—Decedent.
DC—Dummy Corporation.
DE—Donee.
Del. Order—Delegation Order.
DISC—Domestic International Sales Corporation.
DR—Donor.
E—Estate.
EE—Employee.
E.O.—Executive Order.
ER—Employer.
ERISA—Employee Retirement Income Security Act.
EX—Executor.
F—Fiduciary.
FC—Foreign Country.
FICA—Federal Insurance Contributions Act.
FISC—Foreign International Sales Company.
FPH—Foreign Personal Holding Company.
F.R.—Federal Register.
FUTA—Federal Unemployment Tax Act.
FX—Foreign corporation.
G.C.M.—Chief Counsel’s Memorandum.
GE—Grantee.
GP—General Partner.
GR—Grantor.
IC—Insurance Company.
I.R.B.—Internal Revenue Bulletin.
LE—Lessee.
LP—Limited Partner.
LR—Lessor.
M—Minor.
Nonacq.—Nonacquiescence.
O—Organization.
P—Parent Corporation.
PHC—Personal Holding Company.
PO—Possession of the U.S.
PR—Partner.
PRS—Partnership.
PTE—Prohibited Transaction Exemption.
Pub. L.—Public Law.
REIT—Real Estate Investment Trust.
Rev. Proc.—Revenue Procedure.
Rev. Rul.—Revenue Ruling.
S—Subsidiary.
S.P.R.—Statement of Procedural Rules.
Stat.—Statutes at Large.
T—Target Corporation.
T.C.—Tax Court.
T.D.—Treasury Decision.
TFE—Transferee.
TFR—Transferor.
T.I.R.—Technical Information Release.
TP—Taxpayer.
TR—Trust.
TT—Trustee.
U.S.C.—United States Code.
X—Corporation.
Y—Corporation.
Z—Corporation.

November 20, 2023 ii Bulletin No. 2023–47
Numerical Finding List
1
Bulletin 2023–47
Announcements:
2023-18, 2023-30 I.R.B. 366
2023-19, 2023-30 I.R.B. 367
2023-20, 2023-30 I.R.B. 368
2023-17, 2023-31 I.R.B. 412
2023-21, 2023-31 I.R.B. 413
2023-22, 2023-32 I.R.B. 429
2023-23, 2023-34 I.R.B. 569
2023-24, 2023-35 I.R.B. 661
2023-25, 2023-37 I.R.B. 821
2023-26, 2023-37 I.R.B. 822
2023-28, 2023-37 I.R.B. 823
2023-29, 2023-41 I.R.B. 1064
2023-30, 2023-45 I.R.B. 1236
2023-31, 2023-46 I.R.B. 1251
2023-32, 2023-47 I.R.B. 1258
2023-33, 2023-47 I.R.B. 1261
Notices:
2023-29, 2023-29 I.R.B. 1
2023-45, 2023-29 I.R.B. 317
2023-47, 2023-29 I.R.B. 318
2023-37, 2023-30 I.R.B. 359
2023-50, 2023-30 I.R.B. 361
2023-51, 2023-30 I.R.B. 362
2023-54, 2023-31 I.R.B. 382
2023-53, 2023-32 I.R.B. 424
2023-55, 2023-32 I.R.B. 427
2023-57, 2023-34 I.R.B. 560
2023-58, 2023-34 I.R.B. 563
2023-59, 2023-34 I.R.B. 564
2023-52, 2023-35 I.R.B. 650
2023-61, 2023-35 I.R.B. 651
2023-62, 2023-37 I.R.B. 817
2023-56, 2023-38 I.R.B. 824
2023-63, 2023-39 I.R.B. 919
2023-64, 2023-40 I.R.B. 974
2023-66, 2023-40 I.R.B. 992
2023-68, 2023-41 I.R.B. 1060
2023-65, 2023-42 I.R.B. 1067
2023-67, 2023-42 I.R.B. 1074
2023-69, 2023-42 I.R.B. 1079
2023-71, 2023-44 I.R.B. 1191
2023-70, 2023-45 I.R.B. 1228
2023-72, 2023-45 I.R.B. 1228
2023-73, 2023-45 I.R.B. 1232
2023-75, 2023-47 I.R.B. 1256
Proposed Regulations:
REG-124123-22, 2023-30 I.R.B. 369
REG-124930-21, 2023-31 I.R.B. 431
REG-120730-21, 2023-33 I.R.B. 491
REG-134420-10, 2023-34 I.R.B. 571
Proposed Regulations:—Continued
REG-109348-22, 2023-35 I.R.B. 662
REG-120727-21, 2023-36 I.R.B. 670
REG-122793-19, 2023-38 I.R.B. 829
REG-100908-23, 2023-39 I.R.B. 931
REG-115559-23, 2023-42 I.R.B. 1082
REG-106203-23, 2023-43 I.R.B. 1143
REG-113064-23, 2023-43 I.R.B. 1144
REG-117614-14, 2023-44 I.R.B. 1193
REG-127391-16, 2023-44 I.R.B. 1214
REG-103525-23, 2023-46 I.R.B. 1252
REG-115762-23, 2023-47 I.R.B. 1262
REG-120727-21, 2023-47 I.R.B. 1285
Revenue Procedures:
2023-31, 2023-25 I.R.B. 386
2023-26, 2023-33 I.R.B. 486
2023-27, 2023-35 I.R.B. 655
2023-17, 2023-37 I.R.B. 819
2023-30, 2023-40 I.R.B. 995
2023-31, 2023-40 I.R.B. 1057
2023-32, 2023-41 I.R.B. 1064
2023-35, 2023-42 I.R.B. 1079
2023-28, 2023-43 I.R.B. 1092
2023-33, 2023-43 I.R.B. 1135
Revenue Rulings:
2023-13, 2023-32 I.R.B. 413
2023-14, 2023-33 I.R.B. 484
2023-15, 2023-34 I.R.B. 559
2023-15, 2023-34 I.R.B. 559
2023-16, 2023-37 I.R.B. 796
2023-17, 2023-37 I.R.B. 798
2023-18, 2023-40 I.R.B. 972
2023-19, 2023-41 I.R.B. 1059
2023-20, 2023-45 I.R.B. 1221
Treasury Decisions:
9976, 2023-30 I.R.B. 354
9977, 2023-31 I.R.B. 375
9978, 2023-32 I.R.B. 415
9979, 2023-35 I.R.B. 602
9980, 2023-43 I.R.B. 1087
9981, 2023-44 I.R.B. 1174
9982, 2023-45 I.R.B. 1223
9983, 2023-46 I.R.B. 1237
1
A cumulative list of all revenue rulings, revenue procedures, Treasury decisions, etc., published in Internal Revenue Bulletins 2023–27 through 2023–52 is in Internal Revenue Bulletin
2023–52, dated December 27, 2023.

Bulletin No. 2023–47 iii November 20, 2023
Finding List of Current Actions on
Previously Published Items
1
Bulletin 2023–47
1
A cumulative list of all revenue rulings, revenue procedures, Treasury decisions, etc., published in Internal Revenue Bulletins 2023–27 through 2023–52 is in Internal Revenue Bulletin
2023–52, dated December 27, 2023.

Internal Revenue Service
Washington, DC 20224
Official Business
Penalty for Private Use, $300
INTERNAL REVENUE BULLETIN
The Introduction at the beginning of this issue describes the purpose and content of this publication. The weekly Internal Revenue
Bulletins are available at www.irs.gov/irb/.
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