Labor, HHS and Treasury release new No Surprises Act and Transparency in Coverage FAQs

The Departments of Labor, Health and Human Services, and the Treasury released new FAQs on the No Surprises Act and the Transparency in Coverage final rules.  
 
One of the FAQs relates to facility fees, as the departments are concerned about consumers unexpectedly facing these fees, particularly for services received outside of the hospital setting. Through the FAQ, the departments clarify that facility fees should be included in the definition of "items and services" for both the Transparency in Coverage requirements and the No Surprises Act price transparency requirements. This means that, when covered, the fees should be included in the health plans' machine-readable files. They should also be included in the uninsured good faith estimates, as well as the insured good faith estimates and advanced explanation of benefits once fully implemented.  
  
The remaining FAQs cover the definition of "participating" and "nonparticipating" providers from the No Surprises Act, as it relates to the maximum out-of-pocket limit defined by the Affordable Care Act. The departments clarify that services provided by nonparticipating providers are considered out-of-network in terms of the MOOP limit. Moreover, providers that have a contractual relationship with a health plan, but are not considered in-network for the MOOP limit, cannot be deemed participating providers under the No Surprises Act.