July 02, 2021
First Rule for Federal Surprise Medical Bill Law Released
On July 1, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury, along with the Office of Personnel Management released an interim final rule with comment period (IFC), entitled “Requirements Related to Surprise Billing; Part I.” This rule implements the No Surprises Act which was part of the Consolidated Appropriations Act of 2021. It establishes rules around surprise medical bills when care is received either in or out-of-network. This is the first of three rules that are expected to be released. This first rule will establish the methodology and information payers must use to make payments, as well as procedure for making complaints about payers. The comment period will begin soon and will last 60 days.
The No Surprise Act created an independent dispute resolution (IDR) process for when payers and physicians disagree over the payment amount. ASA strongly advocated for and was successful in ensuring that public payer rates could not be used in this arbitration process. The law goes into effect on Jan. 1, 2022.
Key takeaways from the rule follow.
- The rule bans out of network charges for ancillary services, such as anesthesia, at in-network facility in all circumstances.
(Source – Press Release)
- In circumstances when anesthesia services are provided out-of-network, the Qualified Payment Amount (QPA) methodology has been established. Consistent with ASA’s lobbying of the Administration, the rule recognizes the special circumstances in calculating anesthesia payments and permits payments to be determined by anesthesia conversion factor. Specifically, the payment will based on median contracted anesthesia conversion factor x (sum of base unit + time unit + physician status modifier units of the participant, beneficiary, or enrollee to whom anesthesia services are furnished). (Source IFC – page 84)
- The IFC recognizes inflation and in CY 2022 rates will be updated by the CPI-U (Consumer Price Index for Urban Consumers). This is referred to as the indexed median contracted rate. For CY 2023 and subsequent years there will be similar adjustments incorporating the percentage increase in the CPI-U over the previous year
ASA is continuing to review the rule and will provide further updates including guidance on submitting comments.
The rule is available HERE
The Press Release is available HERE
Fact sheets are available HERE and HERE.