On July 1, the U.S. Department of Health and Human Services (HHS) released an
Interim Final Rule to protect patients from unexpected out-of-network medical bills (surprise billing). The rule’s promulgation was required by the
No Surprises Act, signed into law December 27, 2020.
The rule will restrict excessive out-of-pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly receive care from providers that are outside of their health plan's network for either emergency or non-emergency care.
Specifically, the rule bans surprise billing for emergency services—requiring these services to be treated as in-network (without prior authorization restrictions); bans certain out-of-network charges for ancillary care at in-network facilities; and bans other out-of-network charges without advance notice. The new rule is not only applicable to individuals covered by Medicare and Medicaid, but by third party payers and employer-sponsored plans as well.
A key aspect of the No Surprises Act are the provisions for an independent dispute resolution process. Recently, a bipartisan group of nearly 100 members of Congress wrote HHS to urge support for a balanced, robust independent dispute resolution process. A copy of their letter can be accessed
here.
For healthcare providers and facilities, the rules go into effect on January 1, 2022. For group health plans, health insurance issuers, and Federal Employees Health Benefits Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022. ASCP is supportive of the goals of the regulation and will be submitting formal comments on the rule in advance of its September 7 comment deadline.
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ASCP ePolicy News is supported by an unrestricted grant from Hologic.
