By JoAnn Volk and Jack Hoadley

On October 7th, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) published a third rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. The interim final rule (IFR) provides details on the independent dispute resolution process (IDR) that will be used to determine payment to out-of-network providers barred from balance billing, and provides guidance on a patient’s right to external review if there is a question about whether the NSA applies to a particular claim. The IFR also includes more detailed requirements for the NSA’s uninsured patient protections: providers’ and facilities’ obligation to give the uninsured a “good faith estimate” of the cost of scheduled care prior to furnishing services, and a dispute resolution process for uninsured patients whose care costs substantially exceed that good faith estimate.

In a new Expert Perspective for the Robert Wood Johnson Foundation’s State Health & Value Strategies program, CHIR experts provide a summary of the IFR, identifying implications and considerations for states. You can read the full post here.