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Health, Treasury & Labor Agencies No Surprises Act Interim Final Rule with Comment


Tuesday, July 6, 2021
SUMMARY
On July 1, 2021, the US Departments of Health and Human Services (HHS), Treasury and Labor, and the Office of Personnel Management issued an Interim Final Rule with comment (IFR) implementing portions of the No Surprises Act, legislation enacted in December 2020 that bars surprise billing beginning January 1, 2022.
Under the law, payers and providers (including hospitals, facilities, individual practitioners and air ambulance providers) are prohibited from billing patients more than in-network cost-sharing amounts in certain circumstances. The prohibition applies to both emergency care and certain non-emergency situations where patients do not have the ability to choose an in-network provider.
The law establishes a pathway for resolving payer-provider payment disputes using negotiation and arbitration. If entities are unable to come to an agreement, the independent dispute resolution (IDR) process requires each party to sub ....

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No Surprises Act prohibits balance billing, creates arbitration process for out-of-network providers | Hogan Lovells


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Effective January 1, 2022, the “No Surprises Act” signed into U.S. law as part of H.R. 133, “Consolidated Appropriations Act, 2021,” implicates (1) emergency services provided by non-participating providers at participating facilities; (2) non-emergency services performed by non-participating providers during a visit at certain participating facilities; and (3) air ambulance services. The law establishes maximum patient out-of-pocket amounts, which generally cannot be more than the amount that would have been charged to the patient had the services been provided by a participating provider or facility. It also prohibits balance billing, but creates an advance beneficiary notice (ABN)-like process applicable to services furnished by non-participating providers at participating facilities to permit providers to balance bill under certain circumstances. Additionally, the law establishes an Independent Dispute Re ....

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Overview: 2022 Fiscal Year Budget for the Department of Community Health - Georgia Budget and Policy Institute


Overview: 2022 Fiscal Year Budget for the Department of Community Health
 
Gov. Brian Kemp proposed a 2022 budget of $3.48 billion in state general funds for the Department of Community Health. General funds for the agency increased by $430 million from the 2021 fiscal year, mostly to offset the expected loss of federal Medicaid matching funds and account for growth in Medicaid expenses.
Federal funding for the agency is $8.7 billion in the 2022 fiscal year that begins July 1, 2021. The proposed state budget also allots a total of $671 million from other state funds including nursing home and hospital provider fees and money from a tobacco industry legal settlement. This is a $28 million decrease in those funds compared to the 2021 budget year. The budget includes another $3.75 billion from the State Health Benefit Plan, which manages health insurance coverage for state employees, retirees and their dependents. ....

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Minnesota Medical Association: House Commerce Committee Passes Formulary Stabilization Bill


One of the MMA s top legislative priorities passed its first House committee on
Feb. 3, backed by the testimony of MMA President
Marilyn Peitso, MD.
The legislation, HF 58, would limit the ability of insurance companies and pharmacy benefit managers (PBMs) to force a patient to change from a drug they re using during the middle of their enrollment year. The bill would also require insurers and PBMs to use a real-time benefit tool so a prescriber would know, prior to writing a prescription, whether the drug is on formulary.
Peitso told the committee that these changes to a patient s drug coverage creates huge administrative hassles and costs to physicians and clinics, and can have severe health impacts on certain patients. ....

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Gold Dome Report — Legislative Day 9 | Nelson Mullins Riley & Scarborough LLP


Senate Finance Committee
Senator Chuck Hufstetler (R-Rome) led his Committee this afternoon with a hearing on SB 1, a bill authored by Senator Dean Burke (R-Bainbridge) which amends Title 31 to require that entities, that receive state income tax credits and provide self-funded, employer sponsored health insurance not subject to the regulatory authority of the Commissioner of Insurance, must report insurance claims information to the Georgia All-Payer Claims Database. The legislation further requires compliance with the reporting requirement beginning January 1, 2022, as a condition to continued receipt of any such tax credits.
The Committee held a hearing only discussion today on the legislation. Senator Burke explained the legislation on the All-Payer Claims Database initiative which has been adopted in 34 states. The goals are to provide transparency and predictability to improve outcomes and access to healthcare. The claims completed by providers for patients would be ....

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