On July 1, the departments of Health and Human Services (HHS), Treasury, and Labor issued regulations implementing portions of the No Surprises Act that bars surprise billing. The CAP had provided key recommendations to HHS as the regulations and related guidance will go into effect on January 1, 2022. In its recommendations, the CAP has argued that strong regulations are needed to prevent health plan manipulation. The CAP further asked the regulatory agencies to “support an equitable and balanced system for resolving payment disputes, to ensure fair reimbursement for out-of-network services and an (IDR) process that is accessible to all.” The No Surprises Act, which became law in December 2020, included several provisions advocated for by the CAP.

The HHS stated that interim final regulation was needed as it would be “impracticable and contrary to the public interest to delay putting the provisions in these interim final rules in place until after a full public notice and comment process has been completed.” However, the agencies are accepting comments through September 7. The CAP remains engaged in implementing the No Surprises Act and will provide its comments prior to the deadline.

The interim final regulation addressed only part of the No Surprises Act, including areas where Congress set a specific statutory rulemaking deadline of July 1, 2021. Topics in this regulation included:

• Patient cost-sharing protections
• Notice and consent standards for waivers
• Rules for calculating the “qualifying payment amount”
• Disclosure requirements
• Complaints processes

The CAP had asked for clarification regarding the geographic regions and insurance markets used to calculate the qualifying payment amount, which HHS provided, and stressed that insurers must provide related information to physicians. The HHS agreed and required that insurers “make certain disclosures [including the qualifying payment amount] with each initial payment or notice of denial of payment.” Additionally, the HHS agreed with several CAP recommendations and asked for additional feedback, which the CAP will provide. Of note, the agency was clear that they will specify additional standards on insurers if they become aware “of instances of abuse and gaming.”

Additional rulemaking from the federal government is expected later this year for the remaining parts of the legislation, such as the IDR process and price comparison tools.