The No Surprises Act has been deferred until further notice by the Departments of Health and Human Services. The act requires providers and facilities to provide good faith estimates for their insured payments, continue reading below to learn more!
The Departments of Health and Human Services, Labor, and Treasury will defer enforcement of the No Surprises Act requirement for providers and facilities to provide good faith estimates for insured patients. However, the requirement to provide a good faith estimate for people who are uninsured (or don’t plan or using their insurance for a service) still stands and HHS plans to issue regulations for doing so soon.
Those are two takeaways from an FAQ document issued by the departments related to provisions in the No Surprises Act and the Transparency in Coverage final rule. The No Surprises Act goes into effect January 1, 2022 and protects patients from surprise medical bills and establishes an independent dispute resolution process for payers and providers.
The Transparency in Coverage rule “will require most group health plans, and health insurance issuers in the group and individual market to disclose price and cost-sharing information to participants, beneficiaries, and enrollees,” according to CMS. The American Hospital Association said it “supports the departments’ decision to delay enforcement of the good faith estimates for insured patients.”
“We appreciate that the departments listened to our concerns on the significant operational issues with this requirement, and we look forward to working with them and other stakeholders to implement these provisions, including through the development of appropriate technical standards,” it said it a statement. HHS said it would defer the good faith estimate requirement “until rulemaking to fully implement this requirement…is adopted and applicable.”
Part of the No Surprises Act also requires health plans and issuers to include issue consumers an advance explanation of benefits notification that included those good faith estimates generated by providers and facilities. But since the good faith estimate requirement was deferred, HHS also said it would defer advanced explanation of benefit requirement until it can establish standards and infrastructure to support “the data transfer between providers and facilities and plans and issuers.”
The department is also deferring enforcement of a requirement of the Transparency in Coverage rule that requires insurers to publish machine-readable files. The FAQ document insurers would defer until July 1, 2022, the requirement that payers publish machine-readable files regarding in-network provider rates for covered items and services and out-of-network allowed amounts and billed charges for covered items and services. It would defer the requirement that payers publish machine-readable files regarding negotiated rates and historical net prices for covered prescription drugs “pending further rulemaking.”