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118 Matching News Items
1.
Text of Agency FAQs, Part 67: No Surprises Act Implementation (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
May 1, 2024
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
May 1, 2024
"[T]he Departments and OPM will exercise their enforcement discretion under the relevant No Surprises Act provisions for any plan or issuer, or party to a payment dispute in the Federal IDR process, that uses a QPA calculated in accordance with the methodology under the July 2021 interim final rules and guidance in effect immediately before the decision in TMA III, for items and services furnished before November 1, 2024. Similarly, for items and services furnished before November 1, 2024, HHS will exercise enforcement discretion under the relevant No Surprises Act provisions for a provider, facility, or provider of air ambulance services that bills, or holds liable, a participant, beneficiary, or enrollee for a cost-sharing amount based on a QPA calculated in accordance with the methodology under the July 2021 interim final rules and guidance in effect immediately before the decision in TMA III."
2.
Text of Tri-Agency ACA FAQs, Part 66: Prohibition on Lifetime and Annual Limits and Annual Limitation on Cost Sharing
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Apr. 2, 2024
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Apr. 2, 2024
"As explained in the preamble to the final 2025 NBPP, the proposed 2025 NBPP primarily addressed the application of this policy with respect to issuers of non-grandfathered individual and small group market plans subject to the requirement to provide EHB. The final 2025 NBPP does not address the application of this policy to large group market health plans and self-insured group health plans. The Departments understand the questions raised by commenters with respect to large group market health plans and self-insured group health plans and intend to address the applicability of this policy to those plans in future notice-and-comment rulemaking."
3.
Text of Agency Final Regs: Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Mar. 28, 2024
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Mar. 28, 2024
237 pages. "This document sets forth final rules that amend the definition of short-term, limited-duration insurance, which is excluded from the definition of individual health insurance coverage under the Public Health Service Act. This document also sets forth final rules that amend the regulations regarding the requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets."
4.
Text of Agency ACA FAQs, Part 65: Transparency in Coverage (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Feb. 2, 2024
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Feb. 2, 2024
"How should plans and issuers comply with the cost-sharing disclosure requirements of the TiC Final Rules with regard to items and services with extremely low utilization when a cost estimate is based on claims data rather than prospective rates? ... To ensure that consumers receive accurate cost- sharing information, the Departments are likely to exercise their discretion, on a case-by-case basis, not to bring enforcement actions against plans and issuers that fail to include in their self- service tool (or in paper form, upon request) or fail to provide over the phone cost-sharing information for items and services for which a cost estimate for such items and services would need to be based on past claims data and for which there have been fewer than 20 different claims in total over the past three years."
5.
Text of Agency FAQs, Part 64: Coverage of Preventive Services (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Jan. 22, 2024
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Jan. 22, 2024
10 pages. "In light of ... reports of continued barriers and difficulty accessing contraceptive coverage without cost sharing the Departments are issuing the following FAQs ... Q1: Other than what has been described in previous guidance, how can plans and issuers ensure compliance with the requirement to cover the full-range of FDA-approved contraceptive drugs and drug-led devices without cost sharing under PHS Act section 2713 and its implementing regulations? ... Q2: How will the Departments determine whether a contraceptive drug or drug-led device is therapeutically equivalent to another drug or drug-led device? ... Q3: Does the approach to reasonable medical management with regard to therapeutically equivalent products described in Q1 and Q2 apply to all forms of contraception required to be covered under PHS Act section 2713? ... Q4: If a plan or issuer covers without cost sharing all FDA-approved contraceptive drugs or contraceptive drug-led devices other than those for which there is a covered therapeutic equivalent, is the plan or issuer still expected to maintain an exceptions process as previously described in guidance? ... Q5: Can plans and issuers continue to satisfy the requirements under PHS Act section 2713 with respect to coverage of the full range of FDA-approved, -cleared, or -granted products -- including with respect to contraceptive drugs and drug-led devices -- by following the Departments' prior guidance? ... Q6: What should an individual do if the individual has concerns regarding, or has difficulty with, accessing contraceptive coverage under their group health plan or group or individual health insurance coverage?'
6.
Text of Tri-Agencies Notice Reopening Comment Period on Proposed Regs for Federal Independent Dispute Resolution Operations
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Jan. 17, 2024
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Jan. 17, 2024
"This document reopens the comment period for the proposed rules entitled 'Federal Independent Dispute Resolution Operations' ... The comment period for the proposed rules, which closed on January 2, 2024, is reopened from [the date of publication in the Federal Register, currently scheduled for January 22, 2024,] to [14 days after that publication date]."
7.
Text of Final Regs: Federal Independent Dispute Resolution Process Administrative Fee and Certified Independent Dispute Resolution Entity Fee Ranges
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Dec. 18, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Dec. 18, 2023
105 pages. "This document finalizes rules related to the fees established by the No Surprises Act for the Federal independent dispute resolution (IDR) process, as established by the Consolidated Appropriations Act, 2021. These final rules amend existing regulations to provide that the administrative fee amount charged by the Department of the Treasury, the [DOL], and [HHS] to participate in the Federal IDR process, and the ranges for certified IDR entity fees for single and batched determinations, will be set by the Departments through notice and comment rulemaking. The preamble to these final rules also sets forth the methodology used to calculate the administrative fee and the considerations used to develop the certified IDR entity fee ranges. This document also finalizes the amount of the administrative fee for disputes initiated on or after the effective date of these rules. Finally, this document finalizes the certified IDR entity fee ranges for disputes initiated on or after the effective date of these rules.'
[Also see: correction of non-substantive technical errors, Jan. 22, 2024]
8.
Text of Agency FAQs, Part 63: Implementation of ACA and Consolidated Appropriations Act, 2021
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Nov. 28, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Nov. 28, 2023
"County Data for Culturally and Linguistically Appropriate Services ... The 2023 CLAS Guidance sets forth an updated list of all counties (including counties in U.S. territories) for which 10 percent or more of the population is literate only in the same non-English language, based on 2016-2020 ACS data published by the United States Census Bureau.... The Departments intend to update the following documents in the future to reflect the updates in the 2023 CLAS Guidance: [1] SBC template and sample completed SBCs in English (with updated taglines in applicable non-English languages); [2] Additional translated versions of the SBC and Uniform Glossary; and [3] Model notices for internal claims and appeals and external review (with updated taglines in applicable non-English languages)....
"The No Surprises Act ... [U]until the Departments and OPM engage in notice and comment rulemaking on the circumstances under which items and services will be considered 'related to the treatment of a similar condition,' disputes eligible for initiation of the Federal IDR process on or after August 3, 2023, should be submitted in a manner that is consistent with the statutes and regulations that remain in effect after the TMA IV and TMA III vacaturs.... As a result of the TMA III order, air ambulance services for a single air ambulance transport, including an air ambulance mileage code and base rate code, may be submitted as a batched dispute, so long as all provisions of the batching regulations are satisfied[.]"
9.
Text of Tri-Agencies Proposed Regs: Federal Independent Dispute Resolution Process
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 27, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 27, 2023
443 pages. "These proposed rules would set forth new requirements relating to the disclosure of information that group health plans and health insurance issuers offering group or individual health insurance coverage must include along with the initial payment or notice of denial of payment for certain items and services subject to the surprise billing protections in the No Surprises Act. These proposed rules would also require plans and issuers to communicate information by using claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), as specified in guidance, when providing any paper or electronic remittance advice to an entity that does not have a contractual relationship with the plan or issuer. This document also proposes to amend certain requirements related to the open negotiation period preceding the Federal IDR process, the initiation of the Federal IDR process, the Federal IDR dispute eligibility review, and the payment and collection of administrative fees and certified IDR entity fees. This document also proposes to define bundled payment arrangements, amend requirements related to batched items and services, and amend the rules for extensions of timeframes due to extenuating circumstances. Additionally, this document proposes to require plans and issuers to register in the Federal IDR portal."
10.
Text of Agencies' Request for Information: Coverage of Over-the-Counter Preventive Services
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 12, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 12, 2023
"[Treasury, DOL and HHS] are issuing this RFI to gather input from the public regarding the potential benefits and costs of requiring non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover OTC preventive items and services without cost sharing and without a prescription by a health care provider; seek comment on any potential challenges associated with providing such coverage; understand whether and how providing such coverage would benefit consumers; and assess any potential burden that plans and issuers would face if required to provide such coverage."
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