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Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

July 6, 2021

Biden Administration releases first No Surprises Act Regulation:

The first of potentially several regulations seeking to implement the requirements of the No Surprises Act passed by Congress in late 2020 has been released. The Interim Final Rule includes provisions outlining: (i) a ban on surprise billing for emergency services; (ii) a ban on high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates; (iii) a ban on out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances; and (iv) a ban on other out-of-network charges without advance notice.

The regulations will take effect for providers and facilities January 1, 2022. For group health plans, health insurance issuers, and FEHB Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022. There is a 60-day public comment period. WEDI will be reviewing this regulation for any impact on member organizations.​​​​​​​ 

  • Fact sheets on this interim final rule can be found hereand here.
  • The interim final rule with comment period can be accessed here.
  • A discussion of this regulation along with the other provisions of the No Surprises Act has now been added to the WEDI July 27-29 Virtual Summer Forum agenda. Learn more about the event and register here.

NCVHS Issues Request for Public Comment on Healthcare Standards Development, Adoption and Implementation.

In the request for comments, the Committee asks four questions related to how data sharing can be improved, recommendations for new standards, opportunities to learn from other industries, and identification of NCVHS priorities. Submissions are due to NCVHS by July 30. NCVHS will also be holding a hearing August 25th on Healthcare Standards Development, Adoption, and Implementation. WEDI has been invited to testify and will be responding to the RFC.

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