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Health & Welfare Plans Newsletter

August 19, 2022


[Official Guidance]

Text of Agency Final Regs: Requirements Related to Surprise Billing (PDF)

146 pages. "[This] document finalizes certain disclosure requirements relating to information that group health plans, and health insurance issuers offering group or individual health insurance coverage, must share about the qualifying payment amount (QPA) under the interim final rules issued in July 2021, titled Requirements Related to Surprise Billing; Part I...

'This document finalizes select provisions under the October 2021 interim final rules [titled Requirements Related to Surprise Billing; Part II] to address certain requirements related to consideration of information when a certified independent dispute resolution (IDR) entity makes a payment determination under the Federal IDR process, in light of the decisions in Texas Medical Association and LifeNet, and comments received on the October 2021 interim final rules."  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 Agency FAQs Part 55: No Surprises Act Implementation, Including Surprise Billing Protections, Open Negotiation and the Federal IDR Process (PDF)

28 pages; 23 Q&As with additional explanatory text.

  1. Applicability to no-network and closed network plans (6 Q&As);
  2. Applicability to air ambulance services (3 Q&As)
  3. Applicability to emergency services furnished in a behavioral health crisis facility (1 Q&A);
  4. General disclosure for protections against balance billing (2 Q&As);
  5. Standard notice and consent form and model disclosure notice regarding patient protections against balance billing (1 Q&A);
  6. Methodology for calculating qualifying payment amounts (2 Q&As);
  7. Requirements for initial payments or notices of denial of payment, related disclosures, and initiation of open negotiation periods and federal IDR process (6 Q&As);
  8. Transparency in coverage machine-readable files (2 Q&As).

Also available:

   MORE >>

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

Agencies Issue Final Rules to Clarify Federal Process to Protect Against Surprise Billing

"[DOL, HHS and the Treasury Department] today issued final rules concerning standards related to the arbitration process implementing the No Surprises Act ... The rules also finalize some aspects of the arbitration process afforded by the No Surprises Act.... These final rules address certain provisions of the July 2021 and October 2021 interim final rules that are relevant to the operation of the federal IDR process and revise certain provisions in light of two recent federal court decisions in challenges filed by the Texas Medical Association and LifeNet Inc."  MORE >>

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

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

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