The No Surprises Act Interim Final Rule on Dispute Resolution, Uninsured Protections, and External Review: Implications for States

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.

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