All the details you need before the act goes into effect on Jan. 1.
Enacted in late 2020 as part of the Consolidated Appropriations Act of 2021 with an effective date of Jan. 1, 2022, the No Surprises Act (NSA) underscores its primary purpose is to protect patients from surprise medical bills when receiving certain services from – emergency services, non-emergency services from nonparticipating providers at participating facilities, and air ambulance service from nonparticipating providers. (86 Fed. Reg. 36872 (Jul. 13, 2021)).
Essentially, the NSA does three things: (1) limits a patient’s cost-sharing to in-network levels; (2) prohibits balance billing; and (3) establishes an independent dispute resolution process (IDR). The NSA’s IDR enables payors and providers to resolve disputes over provider payments. 86 Fed. Reg. at 36875–76. As the Centers for Medicare and Medicaid Services (CMS) state, “[m]ost group health plans and health insurance issuers that offer group or individual health insurance coverage have a network of providers and health care facilities (in-network providers) that agree to accept a specific payment amount for their services.”
Three federal agencies are tasked with implementing the NSA – Department of Treasury, Department of Labor, and the Department of Health and Human Services (collectively “Agencies”). These Agencies have published two sets of Interim Final Rules (IFRs) and a Notice of Proposed Rulemaking in preparation for the NSA’s effective date.
The Oct. 7, 2021, IFR addresses the IDR process. There is a comment period that closes on Dec. 6, 2021. Here are the steps that are outlined in the Federal Register:
There is a lot to digest and care should be taken to calendar each step. Creating a checklist with the dates and response times is a good place to start. In sum, there is little doubt that this federal IDR process represents a significant change in the way out-of-network services are paid.