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Health & Welfare Plans Newsletter

BULLETIN
September 30, 2021

 

[Official Guidance]

Text of Agency Interim Final Regs: Requirements Related to Surprise Billing, Part II

520 pages. "These interim final rules implement provisions of the No Surprises Act that provide for a Federal independent dispute resolution (IDR) (Federal IDR) process to permit group health plans and health insurance issuers offering group or individual health insurance coverage and nonparticipating providers, facilities, and providers of air ambulance services to determine the out-of-network rate for items and services that are emergency services, nonemergency services furnished by nonparticipating providers at participating facilities, and air ambulance services furnished by nonparticipating providers of air ambulance services, under certain circumstance....

"[The agencies] are issuing these interim final rules with largely parallel provisions that apply to group health plans and health insurance issuers offering group or individual health insurance coverage and certified IDR entities, providers, facilities, and providers of air ambulance services.... [T]his document also includes interim final rules issued by the Office of Personnel Management (OPM) to clarify how certain No Surprises Act provisions apply to health benefits plans offered by carriers under the Federal Employees Health Benefits (FEHB) Act. 

"In addition to the interim final rules issued jointly by the Departments and OPM, this document includes interim final rules issued by HHS that address good faith estimates of health care items and services for uninsured or self-pay individuals and the associated patient-provider dispute resolution process. The HHS-only interim final rules apply to selected dispute resolution (SDR) entities, providers, facilities, and providers of air ambulance services."  MORE >>

U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department

[Official Guidance]

Text of CMS Calendar Year 2022 Fee Guidance for the Federal Independent Dispute Resolution Process Under the No Surprises Act (PDF)

"This guidance announces the administrative fee for participating in the Federal IDR process for calendar year 2022. This guidance also announces the allowable ranges for certified IDR entity fees related to single determinations and batched determinations for calendar year 2022. Finally, this guidance describes the information that IDR entities seeking certification and certified IDR entities must provide to the Departments if they seek approval to charge certified IDR entity fees outside of the allowable ranges set by the Departments, and the process for providing that information."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Official Guidance]

Text of EBSA Information Collection Documents for Requirements Related to Surprise Billing, Part Ii

Information collection documents associated with Federal independent dispute resolution (IDR) process requirements:

  1. Paperwork Reduction Act Supporting Statement for Federal Independent Dispute Resolution Process
  2. Open Negotiation Period Notice
  3. Notice of IDR Initiation
  4. Notice of IDR Entity Selection
  5. Notice of Agreement on an Out-of-Network Rate
  6. Notice of Offer
  7. IDR Certification Application
  8. Petition for Certification Denial or Revocation
  9. Monthly IDR Entity Reporting Requirements
  10. Request for Extension Due to Extenuating Circumstances
  11. Certified IDR Entity Written Determination

Information collection documents associated with external review requirements:

  1. Paperwork Reduction Act Supporting Statement for DOL-Only External Review ICR

MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

Administration Issues Third Rule to Implement No Surprises Act, Protect Americans from Surprise Medical Bills

"Today's rule ... details how the total payment to an out-of-network provider or facility will be determined. In some cases -- based on the law -- state law or application of a state All-Payer Model Agreement will determine this amount. Where neither applies, the rule sets forth the federal process that will apply for determining the amount."  MORE >>

Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]

[Guidance Overview]

DOL Fact Sheet: What You Need to Know About the Administration's Actions to Prevent Surprise Billing

"This rule provides additional consumer protections, including:

  • A process that takes consumers out of the middle of a payment dispute between providers and health plans;
  • Requirements for health care cost estimates for uninsured (or self-pay, meaning you have coverage but choose not to have your care billed to your health plan) individuals;
  • A payment dispute resolution process for uninsured (or self-pay) individuals; and
  • Expanded rights to external review ...

Along with the release of this second interim final rule, CMS launched new online information ... dedicated to the No Surprises Act, with general information about provisions to prevent surprise billing. Additional information will be posted on the website over the next several months to highlight different provisions as they become more relevant to stakeholders and interested consumers."  MORE >>

Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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BenefitsLink Retirement Plans Newsletter, ISSN no. 1536-9587.

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