The new guidance on the No Surprises Act (NSA) and gag clause prohibition, detailed in FAQ Part 69, clarifies the requirements for open negotiation, notice, and disclosure for plans, issuers, and providers related to the Independent Dispute Resolution (IDR) process. It addresses the coordination of surprise billing rules and plan sponsor responsibilities regarding gag clauses. The NSA protects against surprise medical bills for out-of-network costs, limiting individual cost-sharing to an amount based on the Qualified Payment Amount (QPA). The federal IDR process resolves disputes on reimbursement amounts, with FAQ 69 addressing recent litigation impacts on QPA calculation and other NSA implementation questions. The gag clause prohibiting compliance requires agreements to avoid restricting access to provider-specific cost or quality information and mandates annual attestation of compliance. Employers must ensure carriers or TPAs comply with NSA and gag clause requirements, with carriers submitting attestations for fully insured plans and employers responsible for self-funded plans.
Have Questions? and want to read more about the changes click New No Surprises Act and Gag Clause Guidance Issued for more details.
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