Today marks an important milestone in the movement toward a more transparent, interoperable healthcare system.
Starting today, July 1, 2021, health plans offering Medicare Advantage, Medicaid, Children’s Health Insurance Program (CHIP), and most Qualified Health Plans through the Federally-facilitated Exchange are required to make enrollee electronic health information available through application programming interfaces.
Also, this 1st day of July marks expected developments in the evolution of the No Surprise Act:
The first interim final rule (Part 1) on implementation of the No Surprises Act has a statutory deadline of July 1st, 2021. Most likely, Part 1 which is focused on payer-provider reimbursement, interaction with state laws, and how payment rates will be calculated when health plans and healthcare providers disagree on payment amounts, is expected to be published within the next few weeks.
The second interim final rule (Part 2) is expected to provide more details on arbitration processes and is expected to be published soon thereafter, likely in August.
As with many new government regulations, over time this regulation is likely to be adopted for enrollees in commercial and employer-sponsored plans.