Agencies issue ‘part 2’ of regulations banning surprise medical billing

The Office of Personnel Management, and the departments of Health and Human Services, Labor, and Treasury, late this afternoon issued the next in a series of regulations implementing key sections of the No Surprises Act. This interim final regulation, referred to as “Part II,” addresses the independent dispute resolution process providers and plans may use to adjudicate any outstanding reimbursement disputes, the good faith cost estimates providers must share with uninsured or self-pay patients for scheduled services, a process to resolve any disputes between uninsured/self-pay patients and providers about the cost estimates, and an external review process as part of the oversight of health plan/issuer compliance with the law and regulations. The agencies also established a website where interested parties may go to apply to serve as an independent dispute resolution entity and where providers and plans may initiate the process. While the provisions in the regulations generally go into effect Jan. 1, 2022, the agencies will accept stakeholder comments for 60 days.

In a statement, AHA Executive Vice President Stacey Hughes said, “The No Surprises Act was an important step forward in protecting patients from surprise medical bills. Hospitals and health systems strongly support these protections and the balanced approach Congress chose to resolve disputes. Disappointingly, the Administration’s rule has moved away from Congressional intent and brought new life to harmful proposals that Congress deliberately rejected. Today’s rule is a windfall for insurers. The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients. These consumer protections need to be implemented in the right way, and this misses the mark.”

AHA staff are reviewing the rule. Watch for a Special Bulletin tomorrow with additional details.