Thread by @KrutikaAmin

The Biden Administration is expected to publish the first implementing rule of the No Surprises Act by tomorrow July 1. In this thread, I’ll list 10 key questions to look out for in the interim final rules.🧵1/12

Question 1 on No Surprises Act: How will patients be notified of surprise medical bill protections? Will patients know how to dispute unexpected bills? Patients will need to be informed of what to expect and how to dispute unexpected bills. (2/12)

Q2 on No Surprises Act: How will a federal consumer complaints system work? The federal government is required to establish a national consumer complaints system, something that does not currently exist within the agency. What actions will CMS take for complaints? (3/12)

Q3: In addition to a consumer complaints system, will patients be able have external appeal rights to dispute surprise medical bills? Will federal standards ensure access to external appeal for consumers if health plans do not identify and cover surprise medical bills? (4/12)

Q4: How will oversight and enforcement of the No Surprises Act protections work for health plans? The Act’s protections rely on compliance by both health plans and providers. But federal/state enforcement authority and capacity is different for health plans and providers. (5/12)

Q5. How will surprise bill oversight work for providers? Authority to discipline providers and facilities is state-based while the federal government applies certain nationwide provider standards. How will federal agencies monitor state enforcement activities? (6/12)

Q6. How will plans or providers be penalized if they send out surprise medical bills to patients? The federal government can charge a $10,000 penalty. Will this penalty be applied per claim, per patient, or aggregated? Will states apply a similar penalty? (7/12)

Q7. How will services be determined to be emergency or non-emergency for surprise bill protections? Some insurers have denied emergency claims that are retroactively deemed as not-emergent. Will this practice be allowed? If so, can providers bill patients? (8/12)

Q8. With the new surprise medical bill protections, how much will health plans pay for out-of-network providers and will this affect premiums? If there is an inflationary effect, patients could have higher costs in the form of premium payments and out-of-pocket cost sharing.

Q9. With new surprise bill patient protections, how will disputes between insurers and health care providers be resolved? How will the arbitration entities be set up? Will they have access to independent data? (10/12)

Q10. For the non-emergency surprise billing protections, what happens if a patient declines to consent to the out-of-network charges? The law requires providers to give patients at least a 72-hour warning before services. (11/12)

The No Surprise Act was passed in December 2020 and the law is effective starting January 2022. Only the first rule is expected soon, with more to come in the fall. (12/12)