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Federal Surprise Billing Regs Coming Soon: NAIC Spring National Meeting

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What You Need to Know

  • CCIIO said the CMS is in process of writing regulations needed for No Surprises Act, due to take effect Jan. 1, 2022.
  • The special enrollment period now under way has helped 528,000 people get covered.
  • Pandemic-related unemployment did not cause a tidal wave of new enrollees.

Officials at the Centers for Medicare and Medicaid Services (CMS) are busy writing the regulations needed to implement the No Surprises Act, Jeff Wu, acting director at the Center for Consumer Information and Insurance Oversight (CCIIO), told state insurance regulators Monday.

“We’re in a furious round of policymaking,” Wu said.

Having to implement the act so quickly is challenging for CMS, but all of the work will be worth it, Wu predicted. “This is going to be of tremendous help to consumers,” he said.

CCIIO: The ACA Agency

The CCIIO is the arm of CMS in charge of implementing Affordable Care Act provisions and related laws that affect commercial health insurance.

Wu, formerly deputy director of CCIIO, reports to Liz Richter, who is the acting administrator of CMS. The Senate will start holding confirmation hearings on the nomination of Chiquita Brooks-LaSure to be President Joe Biden’s CMS administrator Thursday.

Wu spoke at a session of the Health Insurance and Managed Care Committee, an arm of the National Association of Insurance Commissioners, at the NAIC’s spring national meeting, which is being presented online.

No Surprises Act

The No Surprises Act is part of the Consolidated Appropriations Act of 2021, a bill that former President Donald Trump signed into law Dec. 27.

The No Surprises Act section limits the ability of a health care provider to go after an insured patient for the balance left over after the health insurer pays what it thinks is its share of the bill. The act also creates a billing dispute resolution mechanism for health insurers and health care providers. It also requires health care providers and insurers to help patients understand what their care will really cost.

Most provisions in the act are set to take effect Jan. 1, 2022.

The ACA Exchange System and COVID-19

In addition to talking about the No Surprises Act, Wu said that:

  • CCIIO and are promoting the big new American Rescue Plan Act subsidies for health coverage purchased through an Affordable Care Act public exchange, and the fact that will be open to all through mid-August.
  • The ACA public exchange system has enrolled 528,000 people so far through the new, COVID-19-related special enrollment period, which started in February.
  • He’s happy that the ACA exchange system has ended up having a relatively normal year.

Originally, he said, when the COVID-19 pandemic started, “we were very concerned we’d see a huge increase in the number of uninsured.”

The agency began to plan for a wide range of disaster scenarios, including ones in which CCIIO would have had a hard time continuing to function, he said.

“We didn’t see the tidal wave of applications that we thought might have occurred,” Wu said.

(Image: Centers for Medicare and Medicaid Services)