HHS Issues a RFI to Implement Advanced Explanation of Benefits

WASHINGTON, D.C. (October 14, 2022)—Recognizing the complex issues involved in developing regulations to implement the advanced explanation of benefits (AEOB), the Department of Health & Human Services (HHS) is requesting information from the public on a range of issues to better inform future rulemaking.

The Consolidated Appropriations Act, 2021 (CAA), which includes the No Surprises Act, provides federal protections against surprise billing and limits out-of-network cost sharing under many of the circumstances in which surprise bills arise most frequently.

A provision of the No Surprises Act requires providers and facilities to inquire upon an individual’s scheduling of an item or service, or upon an individual’s request, if the individual is enrolled in a group health plan or group or individual health insurance coverage. If the individual is enrolled in a plan or coverage and is seeking to have a claim for such item or service submitted to the plan or coverage, providers and facilities must provide to the plan, issuer, or carrier a good faith estimate (GFE) of the expected charges for furnishing the scheduled item or service.

Issuers offering group or individual health insurance coverage, upon receiving a GFE must send a covered individual an AEOB. If the individual is not enrolled or is not seeking to have a claim for such item or service submitted to a health plan (that is, an uninsured or self-pay individual), providers and facilities must provide the GFE directly to the individual.

HHS issued regulations implementing GFEs for uninsured (or self-pay) individuals in an interim final rule that was published in the Federal Register on Oct. 7, 2021. However, HHS deferred issuing regulations around the AEOB due to stakeholder concerns for implementation.

HHS is interested in hearing from the members of the public, including individuals potentially eligible to receive an AEOB, organizations serving or representing the interests of such individuals, health care providers and facilities, group health plans and health insurance issuers, carriers, third-party vendors, states, standards development organizations and other health programs.

HHS is requesting information on data standards and other considerations for transferring the GFE data from providers and facilities to plans, issuers and carriers. Additionally, HHS is seeking information on other policy considerations related to implementing the AEOB.

Public comments are due Nov. 15, 2022. Respond to the HHS Request for Information here.

—Via NAHC