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On July 7, the Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight issued the new No Surprises Act (NSA) frequently asked questions (FAQs). While the FAQs cover several topics, most importantly, they clarify that “facility fees” are included in the definition of “items and services” for purposes of the machine-readable file that health plans are required to post under the NSA’s Transparency in Coverage provisions and the provider uninsured good faith estimate requirements.
The other two FAQs cover the definition of “participating” and “nonparticipating” providers, as it relates to the maximum out-of-pocket (MOOP) limit. Services provided by nonparticipating providers are considered out-of-network in terms of the MOOP limit based on the new FAQs. Additionally, providers that have a contractual relationship with a health plan but are not considered in-network for the MOOP limit cannot be deemed as participating providers under the NSA.
