News Briefs

The Biden administration on July 1 released a regulation that takes the first step toward implementing the No Surprises Act, which bans surprise medical billing. The rule, which was the subject of fierce lobbying from various industry stakeholders, lays out most of the patient protections from surprise out-of-network bills that will take effect on Jan. 1, 2022, “including obligations for payers, providers and regulators,” Loren Adler, an associate director of the USC-Brookings Schaeffer Initiative for Health Policy, wrote on Twitter. The regulation also details how to calculate the “qualifying payment amount” that “plays a substantial role in determining” the minimum out-of-network payment from plan to provider, he noted. In addition, the rule took aim at policies unveiled by major insurers that retroactively deny certain emergency room claims if a visit is deemed non-emergent, saying “these practices are inconsistent with the emergency services requirements of the No Surprises Act and the ACA.”

Daniel Tsai, who previously served as assistant secretary for MassHealth and Medicaid director in Massachusetts, is the new deputy administrator and director of CMS’s Center for Medicaid and CHIP Services. Tsai played a key role in Massachusetts’ Section 1115 waiver program, which “implemented one of the most at-scale shifts to value-based care in the nation,” CMS said in a June 28 news release. “Through the waiver, MassHealth also launched a unique program committing significant investments for nutritional and housing supports to address the social determinants of health for high cost, at-risk individuals,” the agency said.

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AIS Health Staff

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