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Agencies Release "Surprise Billing Interim Final Rule; Part 1."

This afternoon HHS, the DOL and OPM released an interim final rule entitled “Requirements Related to Surprise Billing; Part I.” The interim final rule allows for comments to be submitted and focuses on Title 1 of the No Surprises Act with more rounds of rulemaking expected in the coming months to complete guidance on the other sections of the law.

“Part 1” of the guidance reinforces much of what was in the No Surprises Act, requiring emergency services to be covered:

• Without any prior authorization (meaning you do not need to get approval beforehand).

• Regardless of whether a provider or facility is in-network.

This first round of rulemaking also addresses the requirement that certain healthcare providers and facilities furnish patients with a one-page notice on:

• The requirements and prohibitions applicable to the provider or facility regarding balance billing.

• Any applicable state balance billing prohibitions or limitations.

• How to contact appropriate state and federal agencies if the patient believes the provider or facility has violated the requirements described in the notice.

Earlier this summer NAHU submitted a letter to the Administration with suggestions on future rulemaking and items we felt we needed more guidance on. Those items included questions about how the independent dispute resolution or arbitration process would be implemented, what entities could serve as arbitrators, and what data elements could be taken into consideration, such as the median in network rate, when a claim is being considered by arbitrators. Unfortunately, these policy questions were not included in this round of guidance, but the agencies will be releasing more rules in the coming months to address these concerns.

NAHU will be providing comments to this interim final rule as well as working with the Administration as they continue to draft subsequent rulemaking to complete regulatory oversight of the No Surprises Act. More information on this initial rulemaking will be included in tomorrow's special edition of the Washington Update.