HHS Releases New Requirements Related to Surprise Billing

On July 1, 2021, the Department of Health and Human Services (HHS) released an interim final rule that aims to give patients additional protections from surprise medical bills. Specifically, the interim rule established protections from “surprise billing and excessive cost-sharing” for consumers receiving health care items and services. It also prohibits out-of-network charges for ancillary services without advance notice. The initial round of regulations applies to group health plans, health insurance issuers, health care providers and facilities, air ambulance services, among others. Most of the consumer protections included in the interim final rule take effect on January 1, 2022.

In addition to the protections for emergency services, the rule protects people from excessive out- of-pocket costs by limiting the cost sharing for out-of-network service to in-network levels. The rule will also require that any cost sharing for these services count towards in-network deductibles and out-of-pocket maximums, and even prohibits balance billing in certain circumstances.

The surprise billing protections generally apply if you get your insurance coverage through your employer, which includes the federal, state and local government, from the federal or state-based marketplaces, or an individual market health insurance issuer. This rule does not apply to those with coverage through Medicare, Medicaid, Veterans Affairs, TRICARE, or Indian Health Services, as these programs already have rules that prohibit balance billing. More information is available at: https://www.cms.gov/newsroom/fact-sheets/what-you-need-know-about-biden-harris-administrations-actions-prevent-surprise-billing

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