Federal Agencies Issue the First of Several Rules Implementing the No Surprises Act
Federal Agencies Issue the First of Several Rules Implementing the No Surprises Act
On July 1, 2021, federal agencies issued a pre-publication copy of the Requirements Related to Surprise Billing: Part 1, with request for comment. Such interim final rules implement a portion of the No Surprises Act, which is included in the Consolidated Appropriations Act 2021 (CAA). The rules implement provisions that protect participants in group health plans and group and individual health insurance from surprise medical bills when they receive emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance services from nonparticipating providers of air ambulance services, under certain circumstances.
What is not included in these Rules
The Departments are issuing regulations in several phases implementing provisions of title I (No Surprises Act) and title II (Transparency) of Division BB of the CAA. Later this year, the Departments intend to issue regulations regarding the federal IDR process (sections 103 and 105 of Division BB), patient protections through transparency and the patient-provider dispute resolution process (section 112 regards good-faith estimate of expected charges from providers), and price comparison tools (section 114). The Departments also intend to undertake rulemaking this year to propose the form and manner in which plans, issuers, and providers of air ambulance services would report information regarding air ambulance services (section 106). In addition, HHS intends to undertake rulemaking to implement requirements on health insurance issuers offering individual health insurance coverage or short- term, limited-duration insurance to disclose and report information regarding direct or indirect compensation provided to agents and brokers (section 202(c)), as well as provisions related to HHS enforcement of requirements on issuers, non-federal governmental group health plans, providers, facilities, and providers of air ambulance services.
The Departments stated that they intend to undertake rulemaking to fully implement the following provisions of the CAA, but such rules might not be issued until after January 1, 2022:
- transparency in plan and insurance identification cards (section 107),
- continuity of care (section 113),
- accuracy of provider network directories (section 116), and
- prohibition on gag clauses (section 201) that are applicable for plan years beginning on or after January 1, 2022; and pharmacy benefit and drug cost reporting (section 204) that is required by December 27, 2021.
The Departments noted that any such future rules will include a prospective applicability date that provides plans, issuers, providers, and facilities, as applicable, a reasonable amount of time to comply with new or clarified requirements. They went on to state that until rulemaking to fully implement these provisions is finalized and effective, plans and issuers are expected to implement the requirements using a good faith, reasonable interpretation of the statute. The Departments intend to issue guidance in the near future regarding their expectations related to good faith compliance with these provisions.
Effective Dates
The Rules are applicable for plan/policy years beginning on or after January 1, 2022.