Legislative Explainer

Enforce or replace IDR? Two approaches to No Surprises Act reform

NSA IDR Navigator · October 21, 2026 · Sources linked below

H.R. 4710 would strengthen payment enforcement, while the Pallone proposal would replace arbitration with a payment benchmark.

What is the difference between the proposals?

The debate concerns two distinct questions: how an out-of-network payment amount should be determined, and what happens when a required payment is not made. The proposals take different approaches to those questions.

What would H.R. 4710 change?

The No Surprises Act Enforcement Act, introduced by Rep. Greg Murphy on July 23, 2025, would increase penalties for specified violations and add payment reporting and financial consequences for late or missing payments after IDR determinations. Its introduced text addresses obligations on both sides, including provider repayments where required. It strengthens enforcement within the IDR framework rather than replacing arbitration. Read the introduced bill.

What is Pallone proposing?

Rep. Frank Pallone’s October 8 announcement describes the Lower Premiums, Faster Payments Act as replacing arbitration with a payment system based on median in-network rates and requiring payment within 30 days of claim submission. Its supporters argue that a benchmark would reduce costs and payment delays. Those are the proposal’s stated goals, not established outcomes. Read the sponsor’s announcement.

Why are physician groups concerned?

ASA, ACEP and ACR argue that replacing independent arbitration would remove a safeguard against low insurer payments. They favor targeted reforms, including stronger enforcement of unpaid awards. This is the physician organizations’ position. Read our summary of their statement.

Has this changed current requirements?

The sources reviewed describe proposed legislation, not enacted changes. Congress.gov lists H.R. 4710 as introduced. An advocacy post or bill announcement does not itself change filing requirements. Check official legislative records and applicable agency guidance before changing a dispute workflow.

Our perspective: a decision and a payment are different milestones

For provider teams, the distinction matters operationally. Determining an amount does not establish that it has been collected. Track determinations, payment obligations, receipts, and follow-up separately while legislative discussions continue.

Informational overview as of October 21, 2026; not legal advice.