REQUIREMENTS RELATED TO SURPRISE BILLING: PART I INTERIM FINAL RULES

Requirements Related to Surprise Billing: Part I Interim Final Rules

On July 13, 2021, federal agencies published the Interim Final Rules with request for comment (IFR) for portions of the No Surprises Act (enacted under the Consolidated Appropriations Act, 2021 (CAA)) that prohibit certain types of surprise medical billing to consumers beginning January 1, 2022.

Background
Under the No Surprises Act, certain health care providers and facilities are prohibited from billing patients more than the in-network cost-share amounts for services, and health plans and insurers have to calculate the cost-share amount consist with the IFR. The IFR applies to both emergency care, and non-emergency care provided by an out-of-network provider in a network facility where written notice and consent to such out-of-network care is not received from the patient.

These IFRs establish:

• the process for determining the cost share and final payment amount under the coverage
• information health plans and insurers must provide to out-of-network providers
• the process for submitting and receiving consumer complaints and
• the format and details of the notice and consent requirements for treatment by an out-of-network provider

Full details can be found here.