Industry News

On August 19, 2022, the U.S. Department of Labor (DOL) released a Fact Sheet, Requirements Related to Surprise Billing: Final Rules. The final rules cover the finalized provisions of the Consolidated Appropriations Act of 2021, known as the “No Surprises Act,” intended to protect consumers from excessive out-of-pocket health costs caused by surprise billing.

The final rules were issued by the U.S. Department of Health and Human Services (HHS), Department of Labor (DOL) and the Treasury Department (the Departments) that provide certain requirements under the July 2021 interim final rules relating to information that group health plans and health insurance issuers offering group or individual health insurance coverage must share about the qualifying payment amount (QPA). These interim final rules required plans and issuers to disclose the QPA for each item or service to providers, facilities, and providers of air ambulance services with each initial payment or notice of denial of payment when the QPA serves as the amount upon which cost sharing is based.

In addition, the final rules provide Information about the payment determinations under the Federal independent dispute resolution (IDR) process. Under these final rules, certified IDR entities must consider the QPA and must also consider all additional permissible information submitted by each party to determine which offer best reflects the appropriate out-of-network rate. The final rules focus on the process that IDR entities should use when choosing between two competing offers.

The fact sheet is available here.