Agencies Issue No Surprises Act and Transparency Rule FAQs

On Aug. 20, 2021, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued frequently asked questions  (FAQs) regarding the implementation of the No Surprises Act and transparency provisions of the Consolidated Appropriations Act, 2021 (CAA).

The FAQs provide that 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).

The Departments plan to issue regulations on several other issues, including 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 Jan. 1, 2022. Until then, plans and issuers should 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.