Interim Rule Advances Key Protections Against Surprise Medical Bills

An interim final rule with comment period to further implement the No Surprises Act — a consumer protection law that helps curb the practice of surprise medical billing — details a process that will take patients out of the middle of payment disputes, provides a transparent process to settle out-of-network (OON) rates between providers and payers, and outlines requirements for healthcare cost estimates for uninsured (or self-pay) individuals. Other consumer protections in the rule include a payment dispute resolution process for uninsured or self-pay individuals. It also adds protections in the external review process so individuals with job-based or individual health plans can dispute denied payment for certain claims. “No one should have to go bankrupt over a surprise medical bill,” said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. “With today’s rule, we continue to deliver on President Biden’s Competition Executive Order by promoting price transparency and exposing inflated healthcare costs. Our goal is simple: giving Americans a better deal from a more competitive healthcare system.”

The rule is the third in a series implementing the No Surprises Act, a bipartisan consumer protection law. In early September, a rule was issued to help collect data on the air ambulance provider industry, in addition to a rule in July on consumer protections against surprise billing. Collectively, these rules took effect Jan. 1, 2022, and ban surprise billing for emergency services, as well as certain nonemergency care provided by OON providers at in-network facilities, and limit high OON cost-sharing for emergency and nonemergency services for patients.

“Price transparency is a reality in almost every aspect of our lives except healthcare,” said CMS Administrator Chiquita Brooks-LaSure. “The Biden- Harris Administration is committed to changing this. With today’s final rule, we are requiring healthcare providers and healthcare facilities to provide uninsured patients with clear, understandable estimates of the charges they can expect for their scheduled healthcare services.”