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  • 1.  Surprise Billing Final Rule - 8/22/22

    National Council Staff
    Posted 08-22-2022 12:38
      |   view attached
    Dear Association Executives - Below, attached, and at the link below please find information about the Surprise Billing final rule and the rule itself. Please feel free to share this with your members. We are working on an analysis of the rule and what it means for mental health and substance use treatment providers, and will have that for you shortly. Until then, please let us know if you have any questions.

    See - https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/no-surprises-act

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    NEWS RELEASE

    U.S. Departments of Labor, Health and Human Services, and Treasury Issue Final Rules to Clarify Federal Process to Protect Against Surprise Billing

    Rules provide key guidance for arbitrators; additional disclosure to providers, facilities

    WASHINGTON – The U.S. Departments of Labor, Health and Human Services, and the Treasury today issued final rules concerning standards related to the arbitration process implementing the No Surprises Act, a bipartisan law to protect consumers against surprise medical bills.

    The departments continue to work to implement and put into effect the Jan. 1, 2022, consumer protection law to help curb surprise billing for medical care. Today's final rules will make certain medical claims payment processes more transparent for providers and clarify the process for providers and health insurance companies to resolve their disputes.

    In July 2021, interim final rules were issued that included requirements for plans and issuers to furnish providers and facilities with certain information about their billed claims and the payment process. With these final rules, in the event a plan or issuer changes a provider or facility's service code used for billing purposes to one of lesser value – which would reduce the payment to the provider or facility – the plan or issuer must now provide additional information when submitting an initial payment or a notice of denial of payment for items and services covered by the No Surprises Act.

    The increased transparency required under these final rules will help providers, facilities and air ambulance providers engage in more meaningful open negotiations with plans and issuers and will help inform the offers they submit to certified independent entities to resolve claim disputes.

    The rules also finalize some aspects of the arbitration process afforded by the No Surprises Act. Parties or providers (including air ambulance providers), facilities, plans and issuers may use an arbitration process known as the Independent Dispute Resolution process, also known as the federal IDR process, to determine the total payment amount for out-of-network healthcare services for which the act prohibits surprise billing. The final rules include guidance for certified IDR entities on how to make payment determinations and instructs these entities that they must provide additional information and rationale in their written decisions.

    These final rules address certain provisions of the July 2021 and October 2021 interim final rules that are relevant to the operation of the federal IDR process and revise certain provisions in light of two recent federal court decisions in challenges filed by the Texas Medical Association and LifeNet Inc.

    In addition to issuing the final rules, the departments are issuing Frequently Asked Questions Part 55 with guidance on implementing the requirements of the No Surprises Act, including those related to surprise billing protections, open negotiation and the federal IDR process.

     

    Agency - Employee Benefits Security Administration
    Date - August 19, 2022
    Release Number - 22-1599-NAT
    Media Contact: Grant Vaught
    Phone Number - 202-693-4672
    Media Contact: Edwin Nieves
    Phone Number - 202-693-4655
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    Stephanie Katz, JD, MOH
    Assistant Vice President, Public Policy and Advocacy
    Policy Department
    National Council for Mental Wellbeing
    1400 K Street NW Suite 400, Washington, DC 20005
    Direct: (509) 594-9105




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    Neal Comstock
    Director of Membership
    National Council
    NealC@TheNationalCouncil.org
    202 748-8793
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  • 2.  RE: Surprise Billing Final Rule - 8/22/22

    National Council Staff
    Posted 08-24-2022 18:55
      |   view attached
    Dear Association Executives - Attached from our external policy consultants, please find a memorandum analyzing the final Surprise Billing rule. Please do not hesitate to share this with your members and please let us know if you have any questions.

    Thank you.

    Stephanie Katz, JD, MPH
    Assistant Vice President, Public Policy and Advocacy
    Policy Department
    National Council for Mental Wellbeing
    1400 K Street NW Suite 400, Washington, DC 20005
    Direct: (509) 594-9105


    ------------------------------
    Neal Comstock
    Director of Membership
    National Council
    NealC@TheNationalCouncil.org
    202 748-8793
    ------------------------------



  • 3.  RE: Surprise Billing Final Rule - 8/22/22

    National Council Staff
    Posted 08-25-2022 15:38
      |   view attached
    Apologies, but (this time really) attached please find as the correct attachment, the memorandum from our external policy consultants analyzing the final Surprise Billing final rule. Please do not hesitate to let us know if you have any questions or if additional information would be helpful.

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    Neal Comstock
    Director of Membership
    National Council
    NealC@TheNationalCouncil.org
    202 748-8793
    ------------------------------