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Association Comments on First Part of Surprise Billing Rules

In a letter to the Centers for Medicare & Medicaid Services (CMS), America’s Essential Hospitals commented on the first interim final rule implementing the No Surprises Act.

The rule was released by the departments of Health and Human Services (HHS), the Treasury, and Labor and the Office of Personnel Management. It bars health care insurers, carriers, and providers from billing patients more than in-network cost-sharing amounts in certain circumstances. The rule implements certain provisions of the No Surprises Act, including:

  • defining covered services, including emergency, post-stabilization, and air ambulance care;
  • payment methodologies for services provided to beneficiaries by an out-of-network facility or an out-of-network provider at an in-network facility;
  • notice-and-consent requirements to waive balance billing protections; and
  • guidance on the interaction between federal and state balance billing laws.

Based on these provisions, the association made several comments on the rule and urged HHS to:

  • take steps to address qualifying payment amount calculations and contracting issues for providers serving a safety net role;
  • ensure all stakeholders share in notice-and-consent responsibilities and burdens;
  • provide more guidance on the interaction of federal and state balanced billing laws; and
  • delay implementation of the rules until after the COVID-19 public health emergency.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Julie Kozminski is a senior policy analyst at America's Essential Hospitals.

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