Our labor and employment team recently published a LawFlash analyzing the US Departments of Treasury, Labor, and Health and Human Services and Office of Personnel Management’s Requirements Related to Surprise Billing; Part 1.
The interim final rule (IFR) is the first in a series of regulations implementing the No Surprises Act, and the regulations apply to group health plans and insurance issuers offering group or individual coverage, including grandfathered plans. The regulations do not apply to retiree-only plans; excepted benefits; short-term, limited duration insurance; health reimbursement accounts (HRAs); and other account-based group health plans (e.g., healthcare flexible spending accounts).
The IFR, coupled with both recently published and anticipated rules regarding transparency in coverage, signals the government’s goal of attempting to make healthcare a “shoppable” commodity. The general idea that seems to be driving these rules is that in order for patients to really be “consumers,” they need to know the cost of the healthcare services they intend to consume so they can make a meaningful choice.
In the situations identified in the IFR, patients have little to no say in where they receive care or who provides it (e.g., in an emergency). Thus, the departments reason that protections should be put in place to prevent patients from incurring significant financial hardship as a result of obtaining medical care from a provider who is out of network.
Check out the LawFlash for full details regarding the following:
- Coverage of emergency services
- Air ambulance services
- Nonemergency services performed by nonparticipating providers at participating healthcare facilities
- Cost-sharing amounts and payment amounts to providers and facilities
- Notice and consent
- Choice of healthcare professionals