The Washington Report
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October 11, 2023
Note to Subscribers
While we do our best to provide timely updates, it is possible that the information shared in the newsletter may change after our publication deadline.
Legislative
Congress Returns Next Week
Both the House and Senate are on recess. The chambers are scheduled to return to the Hill the week of October 16.
Health
Departments and OPM Release FAQS About Consolidated Appropriations Act; Address Federal IDR Process as Part of NSA and TMA III Decision
On October 6, 2023, the Office of Personnel Management (OPM) and the Departments of Health and Human Services, Treasury, and Labor (Departments) released seven Frequently Asked Questions (FAQs) regarding implementation of certain provisions of Title I (the No Surprises Act - NSA) of Division BB of the Consolidated Appropriations Act, 2021, in light of the August 24, 2023, decision in Texas Medical Association et al. v. United States Department of Health and Human Services et al. (TMA III), Case No. 6:22-cv-450-JDK (E.D. Tex.). The questions address:
- Q1: How should plans and issuers calculate a qualifying payment amount (QPA) for purposes of patient cost-sharing, disclosures with an initial payment or notice of denial of payment, and disclosures and submissions required under the federal Independent Dispute Resolution (IDR) process following the decision in TMA III?
- Q2: What is the Departments’ and OPM’s general approach to implementation of the NSA with respect to the methodology for calculating a QPA following the decision in TMA III?
- Q3: Must plans and issuers continue to make disclosures about the QPA to nonparticipating providers, facilities, and providers or air ambulance services with an initial payment or notice of denial of payment, and in a timely manner upon request of the provider or facility?
- Q4: In light of the district court’s decision in TMA III, how can certified IDR entities proceed in considering a QPA submitted to a federal IDR payment dispute?
- Q5: In light of the district court’s decision in TMA III, how should a plan or issuer proceed when the plan or issuer does not have the information necessary to decide a claim for payment within 30 calendar days after a bill for air ambulance services is transmitted by a nonparticipating provider of air ambulance services?
- Q6: Does the NSA continue to prohibit balance billing for air ambulance services provided by a nonparticipating provider of air ambulance services?
- Q7: May nonparticipating providers of air ambulance services balance bill participants, beneficiaries, and enrollees if a claim for air ambulance services is denied for lack of sufficient information?
The FAQS About Consolidated Appropriations Act, 2021 Implementation Part 62, are available here.
Departments Partially Reopen NSA Federal IDR Portal; FAQs Available
Also on October 6, the Departments partially reopened the federal IDR portal, allowing for initiation of new billing disputes under the NSA. Additionally, the Departments updated FAQs related to the partial reopening. Please refer to the FAQs for specific details.
The NSA IDR Partial Reopening of Dispute Initiation FAQs, are available here.
The August 2023 IDR Administrative Fees FAQs, are available here.
HHS Announces Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications
On October 6, 2023, the Department of Health and Human Services (HHS) announced a second temporary rule extending the COVID-19 telemedicine flexibilities for the prescription of controlled medications. During the beginning of the pandemic, the government began allowing physicians to prescribe controlled substances via telehealth options. The first extension was set to expire on November 11, 2023. The latest update extends the temporary rule through December 31, 2024.
The temporary rule is available here.