ACL Policy Update: Your input is needed on the “No Surprise Billing” rule

By: Vicki Gottlich, Esq., Director, Center for Policy and Evaluation

On July 13, an interim final rule with comment period (IFC) was published in the Federal Register that implements requirements set forth in the No Surprises Act to establish protections against surprise billing and excessive cost-sharing in health care.

Surprise billing can occur when someone receives care from a provider outside of their insurance carrier’s network. This often occurs in emergency situations, when people do not have control over where they are taken for medical care. It also can occur if someone visits their in-network doctor, but another provider who is outside of the insurance carrier’s network assists that person’s doctor in their care.

In those instances, if the person’s insurance carrier doesn’t cover the cost for the care received from the out-of-network provider, or only covers part of the cost, the person may be billed for the difference between what insurance covered and the total cost – even if they have met their deductible or out-of-pocket limits. Those surprise bills often do not count toward deductibles or out-of-pocket limits.

Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, and TRICARE already provide protections against surprise billing and excessive cost-sharing. The new rule adds these protections for people who are covered by commercial health plans.  

People with disabilities and older adults are more likely to have to go to the doctor frequently or have medical emergencies than people without disabilities or younger adults. For people with disabilities and older adults who are covered by health plans through their employer, a federal or state-based Marketplace, or the individual market, this rule means those visits will be protected against surprise billing and excessive cost-sharing. The rule also ensures that no one can be charged for out-of-network costs without notice. That notice must be accessible to people with disabilities and people with limited English proficiency. This means that language assistance services and/or auxiliary aids and services must be provided at no cost to the individual. These include:

• Interpreters
• Large print materials
• Accessible information and communication technology
• Open and closed captioning
• Other aids or services for persons who are blind or have low vision, or who are deaf or hard of hearing

Patients also have to provide informed consent to the notice, meaning that they have to be able to understand the information in the notice and be free to make a decision about whether to consent to the out-of-network costs they are receiving notice for.

Input from the aging and disability networks, and the older adults and people with disabilities that we serve, is critical. HHS is particularly looking for comments on:

• Whether the provisions and protections related to communication, language, and literacy sufficiently address barriers that exist to ensuring all individuals can read, understand, and consider their options related to notice and consent
• Additional or alternate policies HHS may consider to help address and remove such barriers

Comments on the rule can be submitted online or by mail until September 7, 2021 at 5pm.