The Washington Report
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August 24, 2022
Note to Subscribers
While we do our best to provide timely updates, it is possible that the information shared in the newsletter may change after our publication deadline.
Legislative
Congress Adjourned for August Recess
The House and Senate are adjourned for the month of August, tentatively scheduled to return after the Labor Day holiday. (Please be aware that the congressional calendar can change at any time due to current events or bill consideration.)
Health
Departments Issue Final Rules on Surprise Medical Billing; Release Corresponding FAQs and Fact Sheet
On August 19, 2022, the Departments of Labor, Health and Human Services, and the Treasury (the Departments) issued final rules concerning the standards related to the arbitration process implementing the No Surprises Act, which became effective January 1, 2022. In July 2021, “interim final rules were issued that included requirements for plans and issuers to furnish providers and facilities with certain information about their billed claims and the payment process. With these final rules, in the event a plan or issuer changes a provider or facility’s service code used for billing purposes to one of lesser value – which would reduce the payment to the provider or facility – the plan or issuer must now provide additional information when submitting an initial payment or a notice of denial of payment for items and services covered by the No Surprises Act.”
The rules also finalize some aspects of the arbitration process afforded by the No Surprises Act. Parties or providers (including air ambulance providers), facilities, plans and issuers may use an arbitration process known as the Independent Dispute Resolution process, also known as the federal IDR process, to determine the total payment amount for out-of-network health care services for which the act prohibits surprise billing. The final rules include guidance for certified IDR entities on how to make payment determinations and instructs these entities that they must provide additional information and rationale in their written decisions.
On the same day, the Departments also issued a Fact Sheet and Frequently Asked Questions (FAQs) Part 55 with guidance on implementing the requirements of the No Surprises Act, including those related to surprise billing protections, open negotiation, and the federal IDR process.
The news release is available here.
The final rules are temporarily available here.
(Notice: This Department of Labor-approved document has been submitted to the Office of the Federal Register (OFR) for publication and has not yet been placed on public display or published in the Federal Register. The document may vary slightly from the published document if minor editorial changes have been made during the OFR review process. The document published in the Federal Register is the official approved document.)
The Fact Sheet is available here.
The FAQS Part 55 are available here.
The No Surprises Act website is available here.