On August 19, 2022, the US Departments of Health and Human Services (HHS), Labor and Treasury posted a final rule revising portions of the federal No Surprises Act (NSA). Generally, the rule finalizes three aspects of the two-part interim final rule that the Departments published along with the Office of Personnel Management in 2021. First, the final rule expands the information about the qualifying payment amount (QPA) that plans and issuers (collectively, payers) must disclose to providers and facilities (collectively, providers). Second, it reinterprets the provisions of the NSA that govern the determination of the appropriate out-of-network rate through the federal independent dispute resolution (IDR) process, and prescribes how certified IDR entities are to weigh the QPA and other considerations when selecting one of the parties’ offers. The certified IDR entity must now consider the QPA first, and then give weight to other considerations only if those other considerations are not accounted for in the QPA. Third, the final rule expands the information that a certified IDR entity must provide in its written payment determination to include a statement explaining why the QPA did not already account for other considerations weighed by the IDR entity.
Departments Issue Final Rule Implementing Certain No Surprises Act Provisions
Posted In Employee Benefits, Health and Welfare Plans
Brian Stimson
Brian Stimson is the former Acting General Counsel and Principal Deputy General Counsel (second-ranking lawyer) for the US Department of Health and Human Services (HHS) in Washington, DC. He represents health and life sciences clients in litigations, arbitrations and government investigations nationwide. As part of his practice, Brian counsels clients on how to navigate complex disputes that present overlapping legal, regulatory, public policy and business considerations. His collaborative and pragmatic approach draws on his work as a high-level HHS official and a litigator. Read Brian Stimson's full bio.
Jamie Gelfman
Jamie Gelfman is board certified in health law by the Florida Bar Board of Legal Specialization and Education and is certified in healthcare compliance (CHC) by the Society of Corporate Compliance and the Health Care Compliance Association. Jamie works with healthcare clients on the full scope of legal issues that shape their business strategies. She is deeply experienced in regulatory, compliance, reimbursement and licensure matters, with particular experience in the administration of Medicare and Medicaid programs, fraud and abuse, privacy and security, and scope of practice issues. With more than a decade of healthcare legal experience based in Florida, Jamie is a valuable partner for healthcare companies doing business in or working to expand operations in the state. Read Jamie B. Gelfman's full bio.
Drew Elizabeth McCormick
Drew Elizabeth McCormick maintains a general health industry and regulatory practice. Drew advises health care clients on a wide variety of health care regulatory issues, including Medicare and Medicaid regulations, the Federal Anti-Kickback Statute, Ethics in Patient Referral Law, False Claims Act and Health Insurance Portability and Accountability Act (HIPAA), as well as state fraud and abuse laws, privacy laws, licensure regulation, research regulation, and health care compliance matters. Drew also has experience counseling clients who are undergoing government audits and investigations. Read Drew Elizabeth McCormicks' full bio.
Emily Curran
Emily R. Curran focuses her practice on healthcare regulatory and compliance issues in the managed care space. She counsels both for-profit and non-profit healthcare insurance companies on state and federal policy issues and advises clients on reimbursement issues that come into play when participating in government healthcare programs. Emily also supports the Firm’s transactional work. Read Emily Curran's full bio.
Brian Stimson is the former Acting General Counsel and Principal Deputy General Counsel (second-ranking lawyer) for the US Department of Health and Human Services (HHS) in Washington, DC. He represents health and life sciences clients in litigations, arbitrations and government investigations nationwide. As part of his practice, Brian counsels clients on how to navigate complex disputes that present overlapping legal, regulatory, public policy and business considerations. His collaborative and pragmatic approach draws on his work as a high-level HHS official and a litigator. Read Brian Stimson's full bio.
Jamie Gelfman
Jamie Gelfman is board certified in health law by the Florida Bar Board of Legal Specialization and Education and is certified in healthcare compliance (CHC) by the Society of Corporate Compliance and the Health Care Compliance Association. Jamie works with healthcare clients on the full scope of legal issues that shape their business strategies. She is deeply experienced in regulatory, compliance, reimbursement and licensure matters, with particular experience in the administration of Medicare and Medicaid programs, fraud and abuse, privacy and security, and scope of practice issues. With more than a decade of healthcare legal experience based in Florida, Jamie is a valuable partner for healthcare companies doing business in or working to expand operations in the state. Read Jamie B. Gelfman's full bio.
Drew Elizabeth McCormick
Drew Elizabeth McCormick maintains a general health industry and regulatory practice. Drew advises health care clients on a wide variety of health care regulatory issues, including Medicare and Medicaid regulations, the Federal Anti-Kickback Statute, Ethics in Patient Referral Law, False Claims Act and Health Insurance Portability and Accountability Act (HIPAA), as well as state fraud and abuse laws, privacy laws, licensure regulation, research regulation, and health care compliance matters. Drew also has experience counseling clients who are undergoing government audits and investigations. Read Drew Elizabeth McCormicks' full bio.
Emily Curran
Emily R. Curran focuses her practice on healthcare regulatory and compliance issues in the managed care space. She counsels both for-profit and non-profit healthcare insurance companies on state and federal policy issues and advises clients on reimbursement issues that come into play when participating in government healthcare programs. Emily also supports the Firm’s transactional work. Read Emily Curran's full bio.
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