Federal Agencies Delay Certain Provisions of Transparency Law, No Surprises Act

September 1, 2021

The Health and Human Services (HHS), Labor, and Treasury Departments released guidance on August 20 delaying the provision of the federal transparency law that requires health plans to disclose their negotiated provider payment rates from its original January 1, 2022 date until July 1, 2022. This delay does not impact the existing requirement for hospitals, which as of January 1, 2021, are required to provide negotiated payment information in both machine-readable and consumer-friendly shoppable formats. In its proposed 2022 outpatient rule, CMS is proposing a significant increase to the civil monetary penalties that would apply to hospitals for noncompliance.

The guidance also delays enforcement of certain consumer notification provisions of the federal No Surprises Act (NSA), which limits balance billing of consumers for out-of-network services. The delay in enforcement applies to the provision that requires hospitals and providers to provide a good faith estimate and insurers to provide an advanced explanation of benefits to patients before scheduled services. Federal rulemaking on the specifics of the notification requirements is not expected to be completed before the NSA’s January 1, 2022, effective date, but other provisions of the law will still be in effect. WSHA will provide additional information as it becomes available. (Andrew Busz, Andrewb@wsha.org)


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