At Sapphire, we’re committed to keep stakeholders apprised of any updates we hear about the upcoming regulations. We received this from our legislative consultants in DC pertaining to the No Surprises Act (part of the CAA):
Interim Final Rule Proposed: The Latest Update on the No Surprise Act
On June 8, 2021, Part 1 of the No Surprises Act regulations went over to the White House Office of Management and Budget (OMB) for review as an Interim Final Rule (IFR). Review began on the regulation that includes details of the No Surprise Act. The OMB review is the final step before a regulation is issued. The department does not have a deadline, however we are expecting the regulations to be published by early July.
While this update does not provide us with any more insight about the details of this upcoming regulation, it does let us know that the regulation will be issued as an interim final rule instead of as a proposed rule. An IFR is issued where there is time sensitivity around the regulation. When the IFR regulation is issued, it is considered FINAL, and there is no ability to comment before it is finalized (unlike Transparency in Coverage where the public had the ability to comment). Therefore, there is less of an ability to impact the regulation through public comments. Part 1 of the regulation is expected to be finalized in early July.
A couple more things to note:
- The text of the regulation is not available yet.
- Based on the fact the title refers to “Part 1”, it is expected that there will be two phases for finalizing this regulation.
- We are trying to get info on when Part 2 will be published, but we have not heard anything yet. We still expect sometime in July.
More About the No Surprise Act
The recently enacted Covid Relief bill that was signed into law on December 27, 2020 not only provides further relief in regard to the impact of the COVID-19 pandemic, but also also adopted a number of new substantive laws that impact health plans and providers, including the No Surprises Act (the “Act”). More specifically, the No Surprises Act contains several requirements related to price transparency and provider directories that impact health plans effective January 1, 2022 (1).
The No Surprises Act has provided relief to millions through the pandemic, and now it’s attempting to protect consumers from out of network medical costs. In general, the Act attempts to protect consumers who see out of network providers by capping their responsibility for cost sharing to what it would have been if they were treated by an in-network provider. As a result, consumers will be protected from surprise bills in situations where they have little or no control over who provides their care. The Act also establishes a dispute resolution and arbitration process for health plans to resolve payment disputes with OON providers.
In addition, the Act contains several other provisions that are helpful for protecting consumers from surprise medical bills, including certain transparency requirements for health plans.
Bookmark our News & Thoughts section for updates on upcoming regulations.