Interim and Proposed Regulations for No Surprise Billing Act

No one likes to receive an unexpected bill, especially from a healthcare provider. With that in mind, the Departments of the Treasury, Labor, and Health and Human Services have issued interim final rules and identical proposed regulations to implement provisions of the No Surprises Act. On December 27, 2020, the Consolidated Appropriations Act, 2021 (CAA), which included the No Surprises Act, was signed into law. The No Surprises Act provides federal protections against surprise billing and limits out-of-network cost sharing under many of the circumstances in which surprise bills arise most frequently. The regulations are generally applicable for plan years beginning on or after January 1, 2022.

 

Application of No Surprises Rules

The interim and proposed Treasury regulations implement the rules regarding the prevention of surprise medical and ambulance bills and from the choice of health care professional and apply to group health plans. They do not apply to excepted benefits, short-term, limited-duration insurance, or health reimbursement arrangements or other account-based group health plans.

These new rules protect individuals from surprise medical bills for emergency services, air ambulance services furnished by nonparticipating providers, and non-emergency services furnished by nonparticipating providers at participating facilities in certain circumstances. Among other requirements, they require emergency services to be covered without any prior authorization, without regard to whether the health care provider furnishing the emergency services is a participating provider or a participating emergency facility with respect to the services, and without regard to any other term or condition of the plan or coverage other than the exclusion or coordination of benefits or a permitted affiliation or waiting period. The regulations re-codify certain patient protections that initially appeared in the Affordable Care Act and also create complaints processes for violations of the Act.

Comments can be made on these rules but must be received no later than 5 p.m. on September 7, 2021 and submitted in one of the following three ways:

  • Electronically by entering the file code in the search window and then clicking on “Comment”
  • By regular mail to the Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9909-IFC, P.O. Box 8016, Baltimore, MD 21244-8016
  • By express or overnight mail to the Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9909-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.