2022 Directive on Compliance with No Surprises Law | Stevens and Lee

The No Surprises Act (NSA) went into effect on January 1, 2022, but since its effective date, there have been several updates and changes regarding the NSA and its compliance. We examine the major changes in NSA 2022 and the details of the guidelines.

as we are wrote previously, NSA is a federal law primarily enacted to eliminate sudden medical billing for individuals enrolled in group health plans or group or individual health insurance coverage provided by a health insurance issuer that results from: (i) emergency services provided by out-of-network service providers or (ii) Covered non-emergency services provided by out-of-network service providers at in-network facilities. In 2021, the Office of Personnel Management, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (together, the two departments) issued a series of temporary final rules on NSA requirements— part OneAnd the The second part And the the third part.

In 2022, there were legal challenges to some provisions of the NSA, which led to parts of the NSA requirements being overturned. We explored these developments as they occurred in Walk and again in August.

CMS, on behalf of the Department of Health and Human Services, has issued several helpful guidelines and instructions, including the following:

  • In February 2022, CMS was released questions and answers on Independent Dispute Resolution (IDR) under the NSA. This FAQ answers nearly 50 questions in the areas of:
    • IDR Entity Qualifications
    • IDR . Fee
    • IDR . process

Also released a file Schedule To help determine whether a federal or state law IDR process or an All-Payer Form Agreement applies to out-of-network pricing.

  • On April 5, 2022, CMS was released questions and answers Based on Good Faith Estimates (GFE) that providers must provide to self-paying uninsured patients. Topics covered include:
    • Should GFE include a diagnosis?
    • Is a GFE required for every instance of a recursive object or service?
    • Is GFE required for same-day or no-booking services?

This was the second part of our FAQ series about GFEs. Available for reference part One.

  • On April 6, 2022, CMS released a set of details questions and answers On NSA Provider Compliance which included, among other things, the following topics:
    • Exceptions to NSA Requirements
    • Patients and providers to whom the NSA applies
    • CMS contact information for questions related to NSA compliance
    • Signature requirements
    • IDR . Fee
  • On June 24, 2022, CMS was released questions and answers which provided guidance and clarification on additional questions regarding NSA applicability, notice and consent that continued to confuse providers despite coverage in previous FAQs and other guidance from CMS. They include, among other topics:
    • To which providers do the NSA requirements apply?
    • Do any NSA protections apply to individuals covered by Medicare Advantage or Medicaid Managed Care?
    • When are Service Providers Prohibited from Using the Notice and Consent Exception?
    • Can Providers Rely On Oral Consent To Waive NSA Protection Measures?
  • On August 19, 2022, the two departments released a set of questions and answers Which included the following topics:
    • Apply the NSA billing ban to reference-based pricing plans
    • Applying NSA billing provisions to behavioral health facilities
    • What versions of consent and notice to use

Recently, also on August 19, 2022, departments Issue a final rule That ended some requirements under the Temporary Final Rules of July 2021 and clarified the process for providers and health insurance issuers to resolve their disputes. The final rule includes requirements regarding the information health insurance issuers must share about the Qualified Payment Amount (QPA) if they code a bill from a provider or facility. The final rule also finalizes certain requirements under October 2021 Temporary Final Rule relating to the consideration of information when a decision on payment is made by an authorized IDR entity, in the light of case law, which overturned certain parts of the law on this subject. Finally, the final rule includes requirements regarding IDR entities’ interpretations of decisions and rationale. The terms of the final rule went into effect on October 25, 2022.

Looking ahead, on September 16, 2022, the departments issued a Request for information To inform rule-making of requirements regarding the Advanced Explanation of Benefits and GFE for covered individuals. Comments can be sent Until November 15, 2022.

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