Detailed Summary of Part 1 of Regulations Banning Surprise Medical Billing

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Detailed Summary of Part 1 of Regulations Banning Surprise Medical Billing

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At A Glance

The departments of Health and Human Services (HHS), Labor, and Treasury, along with the Office of Personnel Management, July 1 released “Part 1” of regulations implementing the No Surprises Act. The interim final rule addresses several provisions in the law, including the ban on balance billing for certain out-of-network services (referred to as “surprise medical bills”); the notice and consent process that some providers may use to bill patients for out-of-network services; how patient cost-sharing must be calculated; and a complaint process for any potential violations of the provisions in the law. Notably, the regulations contain a strong rebuke of health plan actions to deny coverage of emergency services.

These regulations place a number of new requirements on hospitals, health systems and other providers, as well as group health plans and issuers serving the commercial market. Consistent with the law, these regulations do not apply to the Medicare and Medicaid programs, as protections against balance billing already exist in those programs.

These regulations do not address significant portions of the No Surprises Act, which will be handled in future rulemaking. For example, these regulations do not address the independent dispute resolution process, the good faith estimates and advanced explanation of benefits, provider directories, or continuity of care, among other provisions.

The interim final regulations are effective Sept. 13, 2021; however, most provisions are applicable beginning Jan. 1, 2022. Stakeholders have until Aug 12, 2021 to submit comments on the draft standard notice and forms and until Sept. 7, 2021 to submit comments on the full suite of policies.