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Biden-Harris
Administration Advances Key Protections Against Surprise Medical Bills,
Giving Peace of Mind to Millions of Consumers Plagued by High Costs
Rule
Adds Patient Protections Against Surprise Medical Billing and Outlines the
Process for Health Insurance Issuers and Providers to Determine Costs Under
the No Surprises Act
Today, the Biden-Harris Administration,
through the Departments of Health and Human Services (HHS), Labor (DOL),
Treasury (collectively, the Departments), and the Office of Personnel
Management (OPM) issued an interim final rule with comment period to
further implement the No Surprises Act – a consumer protection law that
helps curb the practice of surprise medical billing.
This rule details a process that will take
patients out of the middle of payment disputes, provides a transparent
process to settle out-of-network (OON) rates between providers and payers,
and outlines requirements for health care cost estimates for uninsured (or
self-pay) individuals. Other consumer protections in the rule include a
payment dispute resolution process for uninsured or self-pay individuals.
It also adds protections in the external review process so that individuals
with job-based or individual health plans can dispute denied payment for
certain claims.
“No one should have to go bankrupt over a
surprise medical bill,” said HHS Secretary Xavier Becerra. “With today’s
rule, we continue to deliver on President Biden’s Competition Executive
Order by promoting price transparency and exposing inflated health care
costs. Our goal is simple: giving Americans a better deal from a more
competitive health care system.”
Today’s rule is the third in a series by
the Departments and OPM implementing the No Surprises Act, a bipartisan
consumer protection law, which the Biden-Harris Administration directed HHS
to prioritize and implement as part of the Executive Order on Promoting Competition in the
American Economy. In early September, the Departments and OPM
issued a rule to help collect data on the air ambulance
provider industry, in addition to a rule in July on consumer protections against
surprise billing. Collectively, these rules take effect January
1, 2022, and ban surprise billing for emergency services, as well as
certain non-emergency care provided by OON providers at in-network facilities,
and limit high OON cost-sharing for emergency and non-emergency services
for patients.
Today’s rule builds on this work and
details how the total payment to an OON provider or facility will be
determined.
“Price transparency is a reality in almost
every aspect of our lives except health care,” said CMS Administrator
Chiquita Brooks-LaSure. “The Biden-Harris Administration is committed to
changing this. With today’s final rule, we are requiring health care
providers and health care facilities to provide uninsured patients with
clear, understandable estimates of the charges they can expect for their
scheduled health care services.”
The Departments will certify independent
dispute resolution entities to conduct payment determinations on a rolling
basis. Entities interested in becoming certified by January 1, 2022, should
submit their applications by November 1, 2021.
Learn more about the certification application
process or apply to be a certified independent dispute resolution entity.
To find fact sheets on today’s rule, visit:
To find the full rule, visit: https://www.federalregister.gov/d/2021-21441
Today the Departments are also releasing
the Calendar Year 2022 Fee Guidance for the Federal
Independent Dispute Resolution Process Under the No Surprises Act.
This guidance provides the allowable fees certified independent dispute
resolution entities will be able to charge in 2022, as well as the
administrative fee that parties to a dispute must pay to access the federal
independent dispute resolution process.
To receive updates on the federal
independent dispute resolution process, including information on the
certification of independent dispute resolution entities, sign up or access
your subscriber preferences at the No Surprises Act Dispute Resolution” email list.
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