HHS issues interim final rule on surprise medical bills


The US Department of Health and Human Services (HHS), under the direction of administration-appointed Biden-Harris secretary Xavier Becerra, in July issued an interim final rule to restrict surprise medical bills and billing of the balance of health care providers.

The interim final rule, “Surprise Billing Requirements; Part I ”, was also published in partnership with the US Departments of Labor, Treasury and the Office of Personnel Management (OPM).

It is planned to publish it in the Federal Register July 13 and the possibility to submit comments is open until September 7, 2021.

According to the HHS, the interim final rule “will restrict surprise billing for patients in employment-based and individual health plans and who receive emergency, non-urgent care from off-grid providers at network facilities and air ambulance services from off-grid providers.

The federal No Surprises Act, designed to provide protections not covered by various state surprise medical bill laws, was enacted by Congress in 2020 and will come into force on January 1, 2022.

The HHS Interim Final Rule regulations implement the provisions of the No Surprises Act and “apply to group health plans and health insurance issuers for plan and policy years beginning January 1, 2022. or after. The only HHS regulations that apply to health care providers, facilities and air ambulance service providers are applicable as of January 1, 2022. “

OPM regulations under the Federal Employee Health Benefits program will apply to contract years beginning on or after Jan. 1, 2022, according to the HHS.

Thirty-three states have enacted balance billing laws, but the scope of consumer requirements and protections varies, according to a Commonwealth Fund study.

Surprise billing typically occurs when an insured patient receives emergency care from an off-grid provider or when an insured patient receives elective elective care at a network facility but is treated inadvertently (and often without know) by a network health care provider.

Billing the balance is often the result of fees billed to the patient for what their insurance does not pay. It is prohibited in Medicare and Medicaid.

Two in three adults worry about unexpected health care bills, which is more than the number who said they feared paying other medical or household expenses, according to a February 2020 study by the Kaiser Family Foundation.

More than seven in ten insured adults aged 18 to 64 with household income of $ 90,000 or more surveyed said they would pay their health care bill at time of service or use a credit card and pay the bill. would pay by their next statement due date, according to the Kaiser Family Foundation Study. However, the results of seven in ten adults in this age group with household income of less than $ 40,000 said they would not be able to pay an unexpected health care bill of $ 500.

To help reduce these expenses, according to HHS, the interim final rule, among other requirements, would be:

  • Prohibit surprise billing for emergency services. Emergency services, wherever they are provided, should be networked without prior authorization.
  • Prohibit high off-grid cost sharing for emergency and non-emergency services. The sharing of costs by patients, such as coinsurance or a deductible, cannot be higher than if these services were provided by a network physician, and any coinsurance or deductible should be based on the rates of the network provider.
  • Prohibit out-of-network charges for ancillary care (such as an anesthesiologist or assistant surgeon) in a network facility under all circumstances.
  • Prohibit other off-grid charges without notice. Healthcare providers and facilities must provide patients with a plain language consumer notice explaining that patient consent is required to receive off-grid care before that provider can bill at the higher off-grid rate.

HHS is seeking feedback from stakeholders on the implementation of these requirements in the No Surprises Act.

How to file comments on the Interim Final Rule by September 7, 2021:

Written comments can be submitted to the addresses indicated below. Any comments submitted will be shared between HHS, Treasury and Labor Departments, and OPM.

  • Submit your electronic comments on this settlement to https://www.regulations.gov by entering the code of the file code of the file CMS-9909-IFC in the search window, then by clicking on “Comment”.
  • Send your written comments to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9909-IFC, PO Box 8016, Baltimore, MD 21244-8016. Allow sufficient time to process written comments by the September 7 deadline.
  • Send written comments by express or overnight mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9909-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244 -1850

View statistics for states with balance billing laws in Data Watch.


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