New Guidance on Health Care Transparency
On August 19, 2022, federal agencies released a final rule and FAQs regarding the ban on surprise medical billing and other health care transparency requirements.
Final Rule on Surprise Medical Billing
The final rule implements certain disclosure requirements related to information that health plans and issuers must share about the qualifying payment amount. It also finalizes specific changes related to the payment dispute resolution process in light of ongoing litigation.
Updated Model Notice
Beginning in 2022, health plans and issuers must disclose certain balance billing protections to participants. An appendix to the FAQs includes an updated version of the model notice for this disclosure requirement. Plans that use the model notice must use the updated version for plan years beginning on or after January 1, 2023.
Posting of MRFs on a Public Website
Health plans and issuers must disclose, on a public website, detailed pricing information in three separate machine-readable files (MRFs), beginning as early as July 1, 2022. According to the FAQs, health plans are not required to create their own public websites for posting MRFs. Rather, a health plan can satisfy the MRF disclosure requirement by entering into a written agreement under which a service provider (such as a TPA) posts the MRFs on its public website on behalf of the plan. Employers who take this approach should monitor their service providers to ensure they comply with this requirement