CMS pitches billing, financial disclosure rules: 7 things to know

Ayla Ellison (Twitter) - Print  | 

The Biden administration issued proposed rules Sept. 10 that include a detailed process for enforcing surprise billing protections and new disclosure requirements for health plans and providers of air ambulance services. 

Seven things to know about the proposed rules: 

Insurer financial disclosures 

1. HHS proposed requiring health insurers disclose how brokers and agents who assist with enrollment in individual health insurance coverage and short-term insurance are compensated. 

2. The proposed rules would require issuers of individual health insurance and short-term, limited-duration plans to tell consumers how brokers and agents are directly and indirectly compensated for assisting with health insurance enrollment. 

3. The proposed rules would require issuers to report to HHS the total amount of compensation paid by the issuer to individual agents and brokers for the preceding year.

Surprise billing protections 

4. The proposed rules include a process that CMS would use to determine if states are enforcing new surprise billing protections for consumers. 

5. If states fail to enforce the surprise billing protections, the proposed rules would allow CMS to take action against providers and facilities by imposing civil monetary penalties of up to $10,000 per violation. 

Air ambulance reporting requirements

6. HHS proposed that air ambulance providers and health plans submit data for each air ambulance claim and transport for two years covered by the reporting requirements of the No Surprises Act. 

7. The data collected will help HHS and the Department of Transportation develop a comprehensive public report on air ambulance services.

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