On July 1, 2021, the interim final rule titled "Requirements Related to Surprise Billing; Part I" was issued. It was jointly authored by Health & Human Services, Department of Labor, Department of Treasury, and the Office of Personnel Management. The Rule implements provisions provided for in the No Surprises Act that was enacted in December 2020. Additional guidance is anticipated to be released October 1, 2021 and December 27, 2021.
The interim rule aims to protect health plan enrollees 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. And, the rule addresses disclosures that are required to be given to in order for the patient to consent to balance bills.
Additionally, the rule addresses how out-of-network reimbursement rates paid to the provider or facility are to be calculated, including formulas for how cost sharing amounts are to be determined.
The Interim Rule will go into effect on September 13, 2020, 60 days after publication in the Federal Register with the rule’s regulations taking effect beginning January 1, 2022.
The full Interim Final Rule can be found here.