What would the Lower Premiums, Faster Payments Act (H.R. 10788) change in No Surprises Act IDR?

What happened

On October 9, 2026, Rep. Frank Pallone Jr. (D-N.J.) introduced H.R. 10788, the Lower Premiums, Faster Payments Act. It was referred to the House Energy and Commerce Committee, and to the Education and Workforce and Ways and Means Committees for a period to be determined by the Speaker. The official bill-status record lists the introduction and referrals, all dated October 9, and no cosponsors.

The bill makes parallel amendments to the Public Health Service Act, the Internal Revenue Code and ERISA, the three statutes that carry the No Surprises Act's private-insurance provisions. As introduced, it would:

• Limit IDR to earlier services. It inserts "with respect to such services furnished before January 1, 2028" into the IDR provisions, including the air ambulance provisions.
• Pay at the QPA. For later services, the qualifying payment amount becomes the out-of-network rate.
• Set a payment clock from billing. Where the QPA is the rate, payment is due "not later than 30 days after the bill for such services is transmitted by such provider or facility."
• Rewrite the QPA for 2028. The QPA would be the median of contracted rates as of January 31, 2019, for the same or similar service, by specialty and region, increased by CPI-U. It would include "the average expected amount of any incentive-based or retroactive payments or payment adjustments," and exclude "any such rate in effect with a provider that did not furnish such item or service."
• Direct fast rulemaking. The Secretary would update the QPA rules within 180 days of enactment and could do so by interim final rule.
• Bar review of the QPA method. "There shall be no judicial review of the methodology for determining the qualifying payment amount."
• Expand audits. Beginning in 2028, the Departments would audit claims data from not less than 25 group health plans and issuers and make the results publicly available.

Where it fits

The bill arrived eight days after CMS, with officials from HHS, Labor and Treasury, convened all certified IDR entities on October 1, 2026 to address rising costs in the process. The CMS readout states that the federal IDR process "has received and closed more than 7 million disputes" since April 2022, and that users have raised concerns about ineligible disputes, unclear determination rationales, and delayed or unpaid awards. The Departments said they would consider the entities' suggestions. Separately, CMS posted notice on October 2, 2026 of batching changes taking effect November 1, 2026, including a 50-line-item limit for affected batches.

The bill's QPA provisions overlap with issues the en banc Fifth Circuit decided in Texas Medical Association v. HHS (TMA III) on August 11, 2026.

Why it matters for provider groups and their counsel

The forum would change. CMS reports that providers, facilities and air ambulance providers prevailed in about 85% of payment determinations from July 1 to December 31, 2025. Under the bill, services furnished from 2028 would be paid at the QPA instead of being decided by an IDR entity choosing between offers. Groups modeling revenue for out-of-network emergency and ancillary services would be modeling a formula, not an award distribution.

The payment dispute would change. Current litigation over unpaid awards turns on whether the No Surprises Act lets a provider sue to enforce an IDR determination; the Fifth and Second Circuits hold it does not, and the Seventh Circuit has the question on appeal. For post-2028 services, the bill would replace the award with a QPA-based payment due 30 days after the bill is transmitted.

The QPA becomes the whole case. If the QPA sets the rate, the inputs behind it matter more: which contracted rates count, how incentive payments are averaged, and how the CPI-U adjustment is applied. The bill would bar judicial review of "the methodology," the subject of the TMA III APA challenge. How a court would read that bar against a challenge to rules issued under it has not been tested.

Pre-2028 disputes continue. As introduced, IDR, its FAA-based review standard and the existing enforcement litigation would continue to govern services furnished before January 1, 2028.

What to watch

• Cosponsors and committee action. The bill-status record shows referral only. Hearings or markup in Energy and Commerce would be the first procedural signal.
• The Departments' next step. CMS said it would consider the IDR entities' suggestions on regulatory and operational changes; any proposed rule would appear in the Federal Register.
• Operational changes already scheduled. The November 1, 2026 batching changes and the IDR Gateway, which CMS says will launch in late 2026.
• TMA III on remand. The en banc court remanded to the Eastern District of Texas for further proceedings consistent with its opinion.