Biden Admin issues new guidance on #NoSurprisesAct & cracking down on medical debt abuses



In late 2020 after years of bipartisan attempts to tackle one of the uglier problems with the U.S. healthcare system, Congress somehow ended up quietly slipping in a bill which resolved a large chunk of the issue with minimal fanfare:

Sarah Kliff and Margot Sanger-Katz have written an excellent summary of the problem and the proposed solution:

Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay.

Part of the problem is that the patient is often not in any position to have any say in where they're taken or who cares for them. Obviously you can't tell the ambulance where to take you if you're unconscious, and even if you are, someone having a heart attack isn't exactly in the best frame of mind to make sure that the folks working to saving their life are in-network.

Even for scheduled surgery where you have the time to carefully check to make sure the hospital and surgeon are in-network, you can still be hit with surprise bills...for instance, the anesthesiologist might turn out to be a hired gun from some other facility, so you wake up to a massive bill from some doctor you've never heard of.

Language included in the $900 billion spending deal reached Sunday night and headed for final passage on Monday will make those bills illegal. Instead of charging patients, health providers will now have to work with insurers to settle on a fair price. The new changes will take effect in 2022, and will apply to doctors, hospitals and air ambulances, though not ground ambulances.

The No Surprises Act has caused a lot of controversy since it went into effect in 2022, of course, with both insurance carriers and healthcare providers squabbling over (and sometimes suing over) the specific provisions of the law and how it's being implemented by the federal government.

Today, in addition to issuing new regulations on so-called "junk plans" (ie, short-term and indemnity healthcare policies), the Biden Administration also issued some new guidelines regarding the No Surprises Act as well as medical debt regulatory abuses. Via Amy Lotven of Inside Health Policy:

The administration is also issuing new guidance on the No Surprises Act, a law that officials say has prevented about 1 million surprise bills a month since it went into effect in January 2022. Under the law, patients must pay no more than the in-network rates for emergency services conducted in an out-of-network facility, or for out-of-network doctors providing services in an in-network hospital.

The guidance clarifies that payers cannot use loopholes to avoid surprise billing protections in two ways, according to a White House fact sheet. First, it ends abuse of the in-network designation, which the White House says is when a health plan contracts with hospitals but tries to claim it is not technically “in network,” thus exposing consumers to higher payments.

...The administration is also concerned about an increase in the number of patients being charged “facility fees” for care provided outside of a hospital, which often comes as a surprise to consumers.

The guidance clarifies that plans and providers must make information about the fees publicly available and ensure that providers cannot evade the NSA by relabeling charges that would otherwise be prohibited under the law as facility fees.

...Finally, the White House announced that, for the first time, HHS, Treasury and the Consumer Financial Protection Bureau (CFRB) are collaborating to probe whether efforts by providers and third parties to encourage patients to sign up for medical credit cards or related products are operating outside of consumer protections regulated by the agencies and violating the law.

These products are often sold to patients while they are in the waiting room, and as they make decisions on medical care, and many have “surprise traps” built in, officials said. For example, many cards offer deferred interest, which lets consumers pay zero interest for a set amount of time, after which the entire amount will be due if the bill is not paid off. Many consumers do not realize what they’re signing up for and could end up filing for bankruptcy. The products also hamper patients’ ability to dispute charges or seek other assistance from providers, a White House official added. The agencies are issuing a request for information to learn more about the practices and seek comments on policy solutions.