News: HHS unveils interim Final Rule on surprise billing

The United States Department of Health and Human Services (HHS) unveiled the first in a series of new rules designed to protect patients from financial hardship due to surprise medical bills and balanced billing, HealthLeaders reported.

The interim final rule will take effect for providers on January 1, 2022, and on or after that date for commercial plans or contract years. It will restrict excessive out-of-pocket costs to consumers from out-of-network billing and balance billing, which is already banned by Medicare and Medicaid. The interim rule extends those protections to people insured through employer-sponsored and commercial health plans.

The interim final rule:

• Bans surprise billing for emergency services, regardless of where they are provided. Those services must be billed on an in-network basis without requirements for prior authorization.
• Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates. 
• Bans out-of-network charges for ancillary care (such as anesthesiology or an assistant surgeon) at an in-network facility in all circumstances. 
• Bans other out-of-network charges without advance notice.
• Requires providers and hospitals to give patients a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

Written comments must be received within 60 days after the rule is published in the Federal Register.

Editor’s note: This article was originally published by HealthLeaders. To read about an earlier HHS legislation aimed at reducing surprise billing rates, click here.