Transcription of Consolidated Appropriations Act Frequently Asked Questions
1 Consolidated Appropriations Act Frequently Asked Questions External 5/18/22 To easily navigate this document, click on View in top nav bar, then click on Navigation Pane. You will get a Table of Contents on left and when you click on a section you will jump there. You can also search by date or by word/terms. UNITEDHEALTHCARE PROPRIETARY AND CONFIDENTIAL UnitedHealthcare s presentation materials and responses to your Questions are intended to provide general information and assistance. It does not constitute medical, legal or tax advice. Please contact your medical, legal and tax advisors on how to respond to this situation. The materials and discussion topics do not constitute a binding obligation of UnitedHealthcare with respect to any matter discussed herein.
2 Please note, in addition to federal law, states may have additional or differing requirements. Some of our products and networks have different features and as a result different guidelines and protocols are applicable to them. Please contact your UnitedHealthcare account representative for additional details. Last updated 5/18/22 1 CAA External Table of Contents CAA External Table of Contents .. 1 Resources .. 3 Consolidated Appropriations Recent Guidance .. 4 Consolidated Appropriations Act Overview .. 6 CAA and UnitedHealthcare Approach .. 8 No Surprises Act Key Provisions ..11 No Surprises Definitions ..11 No No Surprises Service Rate Calculations ..24 No Surprises Consumer and Provider Disclosures.
3 28 NSA Negotiation to IDR Requirements ..29 Member Disclosure notice ..30 Provider Requirements ..33 Independent Dispute Resolution ..33 IDR Process ..38 IDR Requirements ..40 IDR Fees for Administration and Arbiters ..42 Air Ambulance ..44 Air Ambulance Reporting ..45 ID Cards ..46 2022 CAA ID Card Process - Rx Carve in and Carve Out ..52 Out of Network Programs ..54 Naviguard ..57 Patient Protections ..59 Continuity of Care ..59 Advance Cost Estimate ..63 External Review ..67 Choice of Health Care Provider ..68 Price Comparison Tools ..71 UNITEDHEALTHCARE PROPRIETARY AND CONFIDENTIAL UnitedHealthcare s presentation materials and responses to your Questions are intended to provide general information and assistance.
4 It does not constitute medical, legal or tax advice. Please contact your medical, legal and tax advisors on how to respond to this situation. The materials and discussion topics do not constitute a binding obligation of UnitedHealthcare with respect to any matter discussed herein. Please note, in addition to federal law, states may have additional or differing requirements. Some of our products and networks have different features and as a result different guidelines and protocols are applicable to them. Please contact your UnitedHealthcare account representative for additional details. Last updated 5/18/22 2 Provider and Member Directories ..75 Provider Nondiscrimination.
5 79 All Payer Claims Database ..80 Transparency ..82 Gag Rule ..82 Broker and Service Provider Compensation ..85 Reporting ..90 Pharmacy Benefits and Cost Reporting ..90 Mental Health Parity NQTL Custom Networks .. 106 FSA Carryover and Tax Provisions .. 107 FSA Carryover .. 107 Reduce the Exclusion Trigger for Qualified Medical Expenses .. 109 Extend Health Coverage Tax Credits .. 110 UNITEDHEALTHCARE PROPRIETARY AND CONFIDENTIAL UnitedHealthcare s presentation materials and responses to your Questions are intended to provide general information and assistance. It does not constitute medical, legal or tax advice. Please contact your medical, legal and tax advisors on how to respond to this situation.
6 The materials and discussion topics do not constitute a binding obligation of UnitedHealthcare with respect to any matter discussed herein. Please note, in addition to federal law, states may have additional or differing requirements. Some of our products and networks have different features and as a result different guidelines and protocols are applicable to them. Please contact your UnitedHealthcare account representative for additional details. Last updated 5/18/22 3 Resources External Consolidated Appropriations Act document CAA /NSA FAQs Provider No Surprise FAQs Transparency In Coverage FAQs IDR Links IDR payment dispute page on site List of certified entities Revised Certified IDR Entities Guidance and revised IDR Disputing Parties Guidance, which provide updates to conform with the recent Texas Medical Association, et al.
7 V United States Department of Health and Human Services, et al. decision. Frequently Asked Questions about the Federal IDR process, IDR entity qualifications and the application process, and fees. Frequently Asked Questions for providers and facilities about the No Surprises Act rules, Independent Dispute Resolution, and exceptions to the new rules and requirements. Chart for Determining the Applicability for the Federal Independent Dispute Resolution (IDR) Process, which provides a high-level summary to assist in determining whether the Federal IDR process or a state law or All-Payer Model Agreement applies for determining out-of-network rates. UNITEDHEALTHCARE PROPRIETARY AND CONFIDENTIAL UnitedHealthcare s presentation materials and responses to your Questions are intended to provide general information and assistance.
8 It does not constitute medical, legal or tax advice. Please contact your medical, legal and tax advisors on how to respond to this situation. The materials and discussion topics do not constitute a binding obligation of UnitedHealthcare with respect to any matter discussed herein. Please note, in addition to federal law, states may have additional or differing requirements. Some of our products and networks have different features and as a result different guidelines and protocols are applicable to them. Please contact your UnitedHealthcare account representative for additional details. Last updated 5/18/22 4 Consolidated Appropriations Recent Guidance Interim final Rule - Surprise Medical Billing - July 1 New 7/15/21 Definition of emergency services including post-stabilization care.
9 Determination of Qualified Payment Amount (QPA). Interaction with state surprise billing laws. Required provider and health plan notices. Choice of health care providers. Federal enforcement priorities for certain CAA provisions. Proposed Rule - July 10 New 7/15/21 Air Ambulance Reporting Reporting requirements for health plans for air ambulance claims. Air ambulance carriers are required to file annual reports with HHS and Transportation departments on services. Added reporting requirements for Federal Employees Health Benefits program. Reports due 3/31/23 (for 2022 calendar year) and 3/30/24 (for 2023 calendar year). HHS Enforcement Outlines the procedures HHS will use to enforce CAA provisions.
10 HHS will defer to state enforcement to the state where it exists for insurers, providers, and air ambulance. FAQ 49 - August 20 New 7/15/21 On August 20, 2021, the Departments of Health and Human Services, Labor, and the Treasury released FAQ 49 that addressed the implementation of several provisions of the Transparency in Coverage (TIC) Rule and the Consolidated Appropriations Act (CAA). The focus of the FAQ was to provide an overview of the delay in enforcement of some provisions and an extension of deadlines for others. Not all provisions are impacted. Tri Agency FAQ 49 guidance stated plans and issuers should use good faith and reasonable interpretation to meet 1/1/22 dates for the following requirements: No Surprise Billing Independent Dispute Resolution ID Cards Directories UNITEDHEALTHCARE PROPRIETARY AND CONFIDENTIAL UnitedHealthcare s presentation materials and responses to your Questions are intended to provide general information and assistance.
