First Surprise Billing Rule Includes HR Policy Recommendations

July 09, 2021

The Biden administration adopted a number of HR Policy recommendations in its first interim final rule implementing the No Surprises Act, which will significantly impact how employers pay for emergency out-of-network health care services.

The No Surprises Act bars health providers from billing patients more than what would be reimbursed for in-network services in emergencies or other circumstances when out-of-network clinicians are used.  The Act also creates a process for out-of-network providers and employers to resolve payment disputes.

The interim final rule is effective for plan years beginning on or after January 1, 2022.  Additional rulemakings are expected before the end of September.

The rule focuses on four areas of the statute:

  • The initial payment employers are required to make and required information sharing;
  • The method for calculating the qualifying payment amount used for cost-sharing and arbitration purposes;
  • Required notices and disclosures for providers; and
  • Definitions of various statutory terms.

The rule includes several HR Policy recommendations, including:

  • Not establishing any standards regarding the initial payment amount employers are required to make; 
  • Clarifying that the qualifying payment amount is the median of contracted rates to protect patients; and
  • Providing consumer-friendly notices ahead of out-of-network care.
A White House Fact Sheet on an upcoming executive order notes that the order "Directs HHS to support existing hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing."  You can read our story on the fact sheet here.

Outlook:  A second interim final rule (IFR) implementing the arbitration provisions of the No Surprises Act is expected before September and a proposed rule regarding air ambulance balance bills is expected before the end of July.  HR Policy will be submitting comments on the IFR and will continue to engage with the Biden administration on upcoming rulemakings.