Requirements Related to Surprise Billing, Part II Summary of Interim Final Rule with Comment

On October 7, 2021, the Departments of Treasury, Labor, and Health and Human Services (HHS) and the Office of Personnel Management (OPM) published in the Federal Register proposed Requirements Related to Surprise Billing, Part II (86 Federal Register (FR) 55980). The IFC builds on regulations issued in July to implement provisions of the No Surprises Act to establish a Federal independent dispute resolution (IDR) process for determining out-of-network payment rates; to provide good faith estimates of out-of-network care and services to people who are uninsured or self-pay; to establish a patient provider dispute resolution process for those claims, and to apply existing external review requirements to adverse determinations by a plan or issuer related to the No Surprises Act. The rules are generally applicable for plan or policy years beginning on or after January 1, 2022; rules regarding certification of IDR entities are applicable October 7, 2021. OPM regulations apply to contract years beginning on or after January 1, 2022; and HHS-only rules related to the provision of good faith estimates and the patient-provider dispute resolution process are applicable beginning on January 1, 2022, except those related to the certification of SDR entities which are applicable October 7, 2021. Comments are due December 6, 2021.