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Biden Administration Releases No Surprises Act Regulations

On July 1, the Biden Administration released “Requirements Related to Surprise Billing; Part I,” an interim final rule (IFR) that implements elements of the No Surprises Act (included as part of the Consolidated Appropriations Act, 2021) banning surprise medical bills. This rule:

  • Bans surprise billing for emergency services — which must be treated as if they were provided on an in-network basis;
  • Limits patient cost-sharing for out-of-network care at in-network provider rates;
  • Bans out-of-network charges for ancillary care (e.g., anesthesiology & assistant surgeons) at in-network facilities; and
  • Bans other out-of-network charges without advance notice.

The new rule also defines the methodology for determining the qualifying payment amount (QPA) — a key driver of provider payments for out-of-network care and patient cost-sharing amounts. The QPA is generally the health plan’s median in-network rate.

The AANS/CNS Washington Committee will review the IFR and submit comments to the Tri-Agencies (Departments of HHS, Labor and Treasury) overseeing the new law’s implementation.

The full press release with embedded links to fact sheets and the IFR can be accessed here.