Biden-Harris Administration Issues Actions to Prevent Surprise Billing

July 19, 2021 by Alec Stone MA, MPA, Former ONS Director of Government Affairs and Advocacy

The rule (https://www.federalregister.gov/documents/2021/07/13/2021-14379/requirements-related-to-surprise-billing-part-i), effective January 1, 2022, protects (https://www.cms.gov/newsroom/fact-sheets/what-you-need-know-about-biden-harris-administrations-actions-prevent-surprise-billing) people from excessive out-of-pocket costs by limiting cost sharing for out-of-network services to in-network levels and prohibiting billing under certain circumstances. The rule also requires (https://www.cms.gov/newsroom/fact-sheets/what-you-need-know-about-biden-harris-administrations-actions-prevent-surprise-billing) certain healthcare providers and facilities to furnish patients with a one-page notice on:

“No one should ever be threatened with financial ruin simply for seeking needed medical care,” U.S. Secretary of Labor Marty Walsh said (https://www.cms.gov/newsroom/press-releases/hhs-announces-rule-protect-consumers-surprise-medical-bills). “The interim final rule is a major step in implementing the bipartisan No Surprises Act (https://www.aha.org/advisory/2021-01-14-detailed-summary-no-surprises-act) that will protect Americans from exorbitant health costs for unknowingly receiving care from out-of-network providers.”

The provisions will help to provide patients with financial peace of mind while seeking care. According to the Centers for Medicare and Medicaid Services, two-thirds of all bankruptcies (https://www.cms.gov/newsroom/press-releases/hhs-announces-rule-protect-consumers-surprise-medical-bills) filed in the United States are tied to medical expenses.

This is the first of several stop-gap federal regulations to prevent surprise billing and ultimately improve access to care. Accordingly (https://www.cms.gov/newsroom/fact-sheets/what-you-need-know-about-biden-harris-administrations-actions-prevent-surprise-billing), the rule applies to patients “without any prior authorization and regardless of whether a provider or facility is in-network.” ONS’s position (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/access-quality-cancer) is that “all people should have access to comprehensive, affordable health care.” Join the fight against financial toxicity (https://voice.ons.org/news-and-views/why-do-oncology-nurses-need-to-screen-for-financial-toxicity) for all communities (https://voice.ons.org/news-and-views/financial-toxicity-discussion-needs-to-include-undocumented-patients) and patients, help patients who are struggling financially (https://voice.ons.org/news-and-views/how-oncology-nurses-can-support-patients-during-financial-toxicity) by providing resources and support, and let your lawmakers know you support legislation for accessible, affordable care.


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