No Surprises Act Guidance for Health Plans: Final Rules, IDR Process, Qualifying Payment Amounts, Disclosures

Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
ERISA
- event Date
Wednesday, November 2, 2022
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE webinar will provide employee benefits counsel, plan sponsors, and administrators guidance on key provisions and requirements of the final rules implementing the No Surprises Act (NSA). The panel will discuss the good faith estimate requirements for uninsured or self-pay patients, surprise billing prohibitions, notice and consent requirements, and the payment process under the Act. The panel will also provide a deep dive into the qualifying payment amount (QPA), and independent dispute resolution (IDR) processes under the final rules.
Faculty

Ms. Andrew advises clients in all major aspects of employee benefits including qualified and nonqualified plans, IRS and DOL compliance matters, merger and acquisition issues, executive compensation, and employment agreements. She also concentrates her practice in health care related matters, including health care reform legislation, compliance with HIPAA, federal and state health care anti-fraud laws, such as anti-kickback statute, and Stark Law. Ms. Andrew also advises nursing homes, assisted living facilities, medical device, and life sciences organizations regarding compliance with state and federal regulatory requirements.

Ms. Datlow is a member of the Managed Care + Employee Benefit Litigation Group. She has experience defending group welfare benefits and pension benefits plans subject to the Employee Retirement Income Security Act (ERISA) against allegations of fiduciary violations and other claims under ERISA brought by the Secretary of Labor and by a workers' union in an alleged class action. Ms. Datlow also defended cases involving allegations of medical malpractice as well as hospital negligence. Recently, she obtained a dismissal of a vicarious liability claim against a national operator of hospitals by successfully showing that the expert opinion letter accompanying the complaint did not meet the statutory mandate. Additionally, Ms. Datlow has experience defending discovery of peer review material and doctors' credentialing files, and has written on the topic of hospital risk management.

Ms. Flynn is a partner in the firm’s Consumer Financial Services practice and specifically within the Financial Services Litigation practice. She represents clients in federal and state court, both at the trial and appellate level in the areas of complex litigation and business disputes, health care litigation, including ERISA and out-of-network issues, and consumer litigation in more than 21 states nationwide. As a result of new legal developments, Ms. Flynn increasingly counsels clients to ensure they comply with the myriad of growing laws in the consumer law with a particular emphasis on the intersection of TCPA and HIPAA.
Description
On Aug. 19, 2022, the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and Treasury (IRS) issued final rules modifying the NSA. Benefits counsel and administrators must recognize the impact of these changes and grasp a complete understanding of the challenges under the final rule to ensure compliance.
The NSA is included in the Consolidated Appropriations Act of 2021 (CAA). Shortly after the enactment of the CAA, interim final rules were issued to implement core aspects of the NSA, providing requirements related to surprise billing, disclosures, notices, and other critical aspects of the NSA.
The final rule significantly modifies key provisions of the NSA, providing more guidance on (1) qualifying payment amounts that plans and issuers must disclose to providers and facilities; (2) the determination of out-of-network rates through the federal IDR process; and (3) expands the information that a certified IDR entity must provide in its written payment determinations.
Listen as our panel discusses surprise billing prohibitions, notice and consent requirements, and the payment process under the NSA. The panel will also discuss the qualifying payment amount and IDR processes under the final rules.
Outline
- Overview and background of the NSA
- Surprise billing prohibitions
- Notice and consent
- Enforcement
- Final rule implementing the NSA
- QPA disclosure requirements
- Federal IDR process
- Best practices to ensure compliance
Benefits
The panel will discuss these and other key issues:
- What are the regulatory requirements under Part I and Part II of the Interim Final Rule?
- What are the challenges with surprise billing prohibitions, notices, and disclosures for plan sponsors and administrators?
- What are the critical components of the recently issued final rule under the NSA?
- What are the QPA disclosure requirements?
- How do you navigate the federal IDR process?
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