On September 30, 2021, the Department of Health and Human Services (HHS), the Department of Labor (DOL), the Department of Treasury, and the Office of Personnel Management issued an interim final rule on an independent dispute resolution mechanism under the No Surprises Act. The Interim Rule provides that health plans and out-of-network providers have 30-days to negotiate the cost of an item or service. However, if parties are unsuccessful in negotiations in the first 30-days, then they may invoke the Federal Independent Dispute Resolution (IDR) process on the 31st day. The Federal IDR process would use a third party to make a binding determination on the amounts to be charged and covered by the parties. The Interim Rule also requires that upon the patient’s request, a provider or facility must give patients a good faith estimate of the cost of the item or service. The good faith estimate is required to include both main and ancillary service costs. Additionally, the Interim Rule also allows for uninsured individuals to use the IDR process to review charges by the provider or facility if the charges exceed, or are different from, the charges given in the initial good faith estimate.
Read the fact sheet here.