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No Surprises Act and Transparency Rule FAQs

Wednesday, August 25, 2021
Beth Strella

The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) announced frequently asked questions (FAQs) regarding the implementation of the No Surprises Act and transparency provisions of the Consolidated Appropriations Act, 2021 (CAA) on August 20, 2021,

Deferred Enforcement of Some Requirements

The Departments will defer enforcement of the rules regarding:

  • Publishing transparency in coverage machine-readable files related to prescription drug pricing (pending further rulemaking);
  • Publishing other types of machine-readable files (until July 1, 2022);
  • Providing a price comparison tool (until Jan. 1, 2023);
  • Providing a good faith estimate of expected charges and Advanced Explanation of Benefits to certain individuals (pending further rulemaking); and
  • Reporting of pharmacy benefit and drug costs (pending further rulemaking).

Other Guidance

  • The Departments plan to issue regulations on the interaction of the CAA and the transparency in coverage final rules as well as the provider directory and continuity of care requirements. Regulations may not be issued until after January 1, 2022. Until then, plans and issuers are expected to use good faith, reasonable interpretations of the statute.
  • They do not expect to issue regulations on provisions prohibiting gag clauses or balance billing disclosure requirements. Plans and issuers are expected to use good faith, reasonable interpretations of the statutory requirements.

The Departments also provided an example of a plan or insurance identification card that would be compliant with the transparency requirements for those cards and clarified that grandfathered health plans are generally subject to the CAA’s requirements.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.