Federal Government Delays Enforcement for Parts of No Surprises Act and Insurer Price Transparency Provisions

August 26, 2021

The Biden administration has announced it will defer enforcement of certain provisions of the No Surprises Act and Insurer Price Transparency Rule. The Departments of Health and Human Services (HHS), Labor and Treasury issued a release on Aug. 20 indicating that they recognize that compliance is likely not possible for some provisions by the Jan. 1, 2022, implementation date. 

While impacts of COVID-19 were not cited in the rationale for the delayed enforcement, the deferral of certain aspects of what is known as “the good faith estimate” is welcome news for hospitals and other health care providers as they are again facing workforce shortages and challenges due to the demands from the increasing numbers of patients they are treating with COVID and other respiratory infections. 

The No Surprises Act was passed by Congress in December 2020 to address out-of-network billing, with many of the provisions expected to be implemented on Jan. 1, 2022. WHA is sponsoring a webinar for members on the Act on Sept. 2.  

As part of the Act, providers and facilities will have to provide a good faith estimate of expected charges for all items and services, including for items and services furnished by another provider or facility. The estimate is required to be provided to insurers for any patients enrolled in a health plan or to the individual for those who are uninsured. The federal agencies are deferring enforcement of the good faith estimate for individuals who are enrolled in a health plan until rulemaking to implement the requirement is adopted, which is not expected in time for the Jan. 1, 2022, implementation date. However, providers and facilities will still have to provide a good faith estimate to uninsured individuals, and HHS intends to issue regulations implementing this requirement before the Jan. 1 date. 

Also of note, the federal departments announced that they will delay enforcing the price transparency requirements for insurers. Under the price transparency rule, health plans are required to publish in machine-readable format their in-network rates, out-of-network allowed amounts and billed charges, and all negotiated rates and historical net prices for prescription drugs. 

Although the machine-readable file provisions go into effect Jan. 1, 2022, the Centers for Medicare & Medicaid Services (CMS) will not enforce the requirements until July 1, 2022. CMS indicates it will also defer enforcement of the prescription drug pricing information until further rulemaking is complete. 

These announcements come as the price transparency rule is being challenged in court by the U.S. Chamber of Commerce. As reported by WHA on Aug. 12, the Chamber argues that the requirements threaten to increase costs to consumers, as insurers would be required to reveal confidential and commercially sensitive information to competitors.

This story originally appeared in the August 26, 2021 edition of WHA Newsletter