The Interim Final Rule, Part I, implementing the No Surprises Act was released last week and is applicable to plan years beginning on or after January 1, 2022. This rule focuses on many of the Act’s provisions related to the prohibition on surprise billing, including how to calculate the qualifying payment amount. The qualifying payment amount is what will be used in many cases to determine the cost-sharing allowed for emergency services, air ambulance services, and non-emergency out-of-network services provided at in-network facilities. The rule also contains details on determining the median contracted rate – which is used to calculate the qualifying payment amount – and the required disclosures that must be made with the initial payment to out-of-network providers for the services protected by the Act.
The rule is scheduled for official publication in the Federal Register next week, and comments are due September 7, 2021. Although we are still reviewing the rule for employer impacts, please note these several important issues related to transparency requirements:
Guidance on good faith compliance with these rules is expected in the near future.