What You Need to Know
- The No Surprises Act is part of the Consolidated Appropriations Act, 2021.
- The Act is supposed to protect health plan enrollees who get emergency care out-of-network or go to in-network hospitals.
- Part of No Surprises Act Section 202 requires disclosure of health insurance producer compensation.
Federal agencies have rolled out 411 pages of No Surprises Act regulations — without giving health insurance agents and brokers anything but one small hint about how they’ll implement the producer compensation disclosure section.
On July 1, the Centers for Medicare and Medicaid Services (CMS), and arm of the U.S. Department of Health and Human Services (HHS), posted a preliminary version of the new interim final rules, “Requirements Related to Surprise Billing; Part I.”
The best known sections of the No Surprises Act are supposed to protect users of individual and group health coverage against the risk that they will get huge, unexpected bills if they seek emergency care from hospitals outside their provider networks; get care from out-of-network providers at in-network hospitals; or use air ambulance services from out-of-network providers.
Another part, Section 202(c), is supposed to require agents, brokers and other people and companies involved with setting up and running health coverage arrangements, such as independent benefit plan administrators, to give the coverage users information about their compensation.
Federal agencies mention No Surprises Act Section 202(c) just once:
HHS intends to undertake rulemaking to implement requirements on health insurance issuers offering individual health insurance coverage or short-term, limited-duration insurance to disclose and report information regarding direct or indirect compensation provided to agents and brokers (section 202(c))… .
The reference to Section 202(c) implies that the federal agencies will apply extensive compensation disclosure requirements to agents who sell “short-term, limited-duration insurance” — short-term health insurance — as well as to agents and brokers who sell major medical insurance.
No Surprise Acts Machinery
Members of Congress included the text of the No Surprises Act into the Consolidated Appropriations Act, 2021, a big package of legislation that former President Donald Trump signed into law Dec. 27, 2020.
Some observers used to call the group of agencies that used to draft many major federal health insurance regulations — CMS, the IRS and the U.S. Labor Department’s Employee Benefits Security Administration — the “tri agency” group.
The administration of President Joseph Biden has started to add the U.S. Office of Personnel Management to the health insurance regulation drafting team, which could be described as a “quad agency group.”
The quad agency group has sent the preliminary version of the final interim No Surprises Act rules to the Federal Register for publication. The rules will take effect 60 days after the official publication date, according to the “preamble,” or official introduction to the regulations.
The quad agencies are asking for public comments on the regulations. Comments will be due 60 days after the official Federal Register publication date.
CMS is in charge of taking in and organizing the comments.
Drafters have included telephone numbers for several contact people. The IRS contact if Kari DeCecco, and the CMS contact is Lindsey Murtagh.
An interim final rule is a type of regulation that is created quickly, without going through a full public comment period and impact analysis in advance. Because an interim regulation is created so quickly, without a full review process, courts may be less inclined to support an agency that tries to punish an individual or company for any interim regulation violations, according to the American Action Forum, a group that has been critical of heavy use of interim final rules.