Earlier this week, ACEP and the Emergency Department Practice Management Association (EDPMA) submitted an official response to an interim final regulation implementing part of the No Surprises Act.
The No Surprises Act, which Congress passed at the end of last year, bans balance billing for out-of-network (OON) services starting in 2022 and establishes a back-stop independent dispute resolution (IDR) process. As you may recall, ACEP teamed up with EDPMA to form a joint task force that represented the whole house of emergency medicine (EM). Over the last six months, we have engaged directly with key federal agencies in charge of implementing the law. Our work preceded the release of any regs. In March, we sent a 19-page letter outlining our policy positions on key issues that affect emergency care, and in May, we followed-up with another letter that provided technical feedback on the specific information that will be necessary to accurately bill patients for OON emergency services. Further, we met directly with the federal government several times, including an informal meeting with the Center for Consumer Information and Insurance Oversight (CCIIO)—the main agency implementing the law— and official meetings with the White House’s Office of Management and Budget.
The No Surprises Act is being implemented in stages by the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (collectively referred to as “the Departments”). The first interim final reg—which we just responded to— was released on July 1st. As we worked on the response to this reg, we simultaneously were developing recommendations and input for the Departments to consider for the second reg—expected to be released shortly. This second reg will be as important or even more important than the first reg, as it will mainly focus on the IDR process. The IDR process can be used by health plans and clinicians such as yourselves to ultimately determine the final payment amount for OON services. On August 10, ACEP and EDPMA sent a letter outlining our feedback on the IDR process to the Departments in anticipation of the second reg being released.
ACEP and EDPMA’s response to the first interim final reg dives into key issues that affect you and your patients, and that have downstream implications for the IDR process.
Chief Operating Officer