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July 08, 2021

Biden Administration Issues Interim Rule to Protect Consumers from Surprise Medical Bills

On July 1, CMS, HHS, the Department of Labor, the IRS, and the Office of Personal Management issued an interim final rule that restricts surprise billing for emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities. Under the interim final rule, if a health plan covers emergency services, such services must be covered on an in-network basis without any prior authorization. Additionally, the rule limits cost sharing for certain out-of-network services and includes guidance as to how reimbursement rates to out-of-network providers are to be determined. The interim rule is generally applicable to group health plans and health insurance issuers for plan and policy years beginning on or after January 1, 2022.