Tuesday, July 13, 2021
Today, the Departments of Health and Human Services (HHS), Labor, and Treasury (the Departments) published an interim final rule (the Interim Final Rule) implementing certain provisions of the No Surprises Act,[1] which aims to address balance bills on a national scale. Effective for health insurance plan years beginning January 1, 2022, the legislation limits patient payment responsibility for certain unavoidable out-of-network services, prohibits providers and facilities from balance billing patients for those services, establishes price transparency disclosure requirements for providers and insurers, and mandates creation of dispute resolution processes for patients, providers, and insurers to address unanticipated medical bills.
The Interim Final Rule provides critical details regarding some, but not all, aspects of the law, including the scope of the law’s balance billing prohibition, methodologies for patient cost-sharing responsibility and provider payment, requirements and limitations of the law’s notice and consent exception, and standards for required provider and facility disclosures. Notably, the No Surprises Act applies to self-funded employer insurance plans formed under the Employee Retirement Income Security Act (ERISA plans) and air ambulance services, two key areas states have been unable to address as they are governed by federal law. Both of these areas are addressed throughout the Interim Final Rule.