DHHS, DOL, DoT Publish Final Rule Implementing the No Surprises Act

August 19, 2022

Earlier today, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (the Departments) released the Final Rule implementing the No Surprises Act. Links to the rule and subsequent information can be found below.
 
Regarding the rules requiring that Independent Dispute Resolution Entities (IDRE’s) choose the offer closest to the Qualified Payment Amount (QPA), the Departments note the following in the preamble:

      “…the Departments acknowledge that the additional factors may be relevant in determining
     the appropriate out-of-network rate, because the QPA may not account for information specific
     to a particular item or service. Therefore, these final rules do not require the certified IDR entity
     to select the offer closest to the QPA. Rather, these final rules specify that certified IDR entities
     should select the offer that best represents the value of the item or service under dispute after
     considering the QPA and all permissible information submitted by the parties.” (P. 37-38) 

AAMS will continue to analyze the Final Rule and share additional information and summarizations in the coming days. We will brief members on the impact this rule via an upcoming Town Hall meeting, exact date and time to be determined. 
 
AAMS recommends all members continue to monitor the CMS website for NSA implementation at www.cms.gov/nosurprises for additional updates. AAMS will also make all materials, summaries, and analysis documents available via the AAMS website www.aams.org as well as in our weekly newsletter, News on the Fly, and, if necessary, through additional Member Alerts.   
 
Final rule: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/ebsa1210-ac00-and-1210ab99-idr-process-final-rule-dol816-final.pdf
 
FAQs Part 55: https://www.cms.gov/files/document/faqs-part-55.pdf
 
Federal IDR process status update: https://www.cms.gov/files/document/federal-idr-process-status-update-august-2022.pdf
 
Fact sheet: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/requirements-related-to-surprise-billing-final-rules-2022.pdf

Press release: https://www.dol.gov/newsroom/releases/ebsa/ebsa20220819