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No Relief in Sight

COVID-19 relief bill sinks as CMS expects to open NSA arbitration portal.

Congress failed to pass a $10 billion COVID relief package last week before leaving for its spring recess – even as nearly a dozen members, including House Speaker Nancy Pelosi, have tested positive for COVID in just a few days.

The snag? Immigration was thrown into the mix.

The Biden Administration recently announced that it was going to roll back Title 42, a rule that allowed the U.S. to send immigrants immediately back to their home countries during the public health emergency (PHE).

So, last week, in response, Republicans tried to attach an amendment to the COVID package that would keep Title 42 in place. Title 42, however, has mixed Democratic support, and the COVID package was thus sunk by being attached to a contentious immigration issue.

This means the possibility of a COVID relief bill is delayed until at least the end of April, though it will probably be pushed back even further because passage of the package is now tied to Title 42.

For now, the federal government has stopped providing money for testing and therapeutics for the uninsured, and states are rolling back their vaccination and testing programs as these funds dry up.

We also have a lot of news coming out about the No Surprises Act. First, the Centers for Medicare & Medicaid Services (CMS) has put out FAQs regarding good-faith price estimates (GFEs) that all healthcare providers are now required to give uninsured and self-pay patients. The FAQs clarify that providers do not have to provide good-faith estimates for unforeseen services or expected services beyond the initially scheduled service. However, when services beyond the initial service are scheduled, another good-faith estimate needs to be given.

Next, CMS announced that it will open its No Surprises Act arbitration portal this week. Providers will be able to use the portal to initiate an arbitration process if they are unhappy with reimbursement on certain out-of-network claims. Those claims, as outlined by the No Surprises Act, include all out-of-network emergency claims, plus non-emergency out-of-network claims in in-network facilities.

Now, the portal was supposed to manage any disputes on these claims from the time the law took effect back on Jan. 1, so CMS says that any provider that wants to use the government’s arbitration process can still initiate a dispute in the first 15 business days after whenever the portal opens.

The Administration also signaled last week that it does not plan on releasing a final final rule on the No Surprises Act arbitration process until this summer. The rule was expected to come out earlier this year, but in a recent court filing, the Administration says that they’ve pushed publication of the rule a bit later, to May. That court filing was part of the American Medical Association’s (AMA’s) lawsuit against the Administration that is focused on the No Surprises Act arbitration process.

To review:

1) The U.S. Department of Health and Human Services (HHS) plans on opening a portal this week – four months late – to manage the No Surprises Act’s reimbursement arbitration process;

2) The No Surprises Act’s arbitration process remains an issue of litigation in at least three lawsuits; and

3) HHS does not plan on actually finalizing the No Surprises Act’s arbitration process in a rule until May.

The more things change, the more things stay the same.

Programming Note: Listen to Matthew Albright report the legislative update Mondays on Monitor Monday, 10 Eastern and sponsored by Zelis.

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Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

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