New Proposed Rules on Surprise Billing are Published by CMS and HHS

On August 19, 2022, CMS and HHS released final rules that account for the two district court rulings and take into account comments from stakeholders to the interim final rules released last year. The rulemaking is narrow in scope, addressing specific issues related to disclosures by plans and issuers and guidance for certified IDR entities on information to consider when they make payment determinations.

The Departments also issued a new set of FAQs providing guidance on several requirements including how the law’s protections apply to no-network and closed-network plans, requirements related to disclosures, and the calculation of the qualifying payment amount, among other things.

The new FAQs can be found here: https://www.cms.gov/files/document/faqs-part-55.pdf

Finally, the Departments also released a brief status update on the federal IDR process. In short, many more disputes have been submitted to the federal IDR process than were initially anticipated. Additionally, certified IDR entities are conducting significant work determining whether a dispute is eligible for the federal process.

The new rule can be found here: https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/no-surprises-act