Proposed Rule2021-21419
Requirements Related to Surprise Billing; Part II
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
October 7, 2021
Issuing agencies
Treasury DepartmentInternal Revenue Service
Abstract
The Department of the Treasury (Treasury Department) and Internal Revenue Service (IRS) are proposing regulations that provide for a federal independent dispute resolution (IDR) process to permit group health plans and nonparticipating providers, facilities, and providers of air ambulance services to determine the out-of-network rate for items and services that are emergency services, nonemergency services furnished by nonparticipating providers at participating facilities, and air ambulance services furnished by nonparticipating providers of air ambulance services, under certain circumstances. Elsewhere in this issue of the Federal Register, the IRS is issuing the temporary regulations that correspond to this proposal at the same time that the Office of Personnel Management (OPM), the Employee Benefits Security Administration of the Department of Labor (DOL), and the Center for Medicare & Medicaid Services of the Department of Health and Human Services (HHS) are issuing substantially similar interim final rules with request for comments. The text of those temporary regulations also serves as the text of these proposed regulations.
Full Text
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<title>Federal Register, Volume 86 Issue 192 (Thursday, October 7, 2021)</title>
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[Federal Register Volume 86, Number 192 (Thursday, October 7, 2021)]
[Proposed Rules]
[Pages 55756-55757]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2021-21419]
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DEPARTMENT OF THE TREASURY
Internal Revenue Service
26 CFR Part 54
[REG-107707-21]
RIN 1545-BQ02
Requirements Related to Surprise Billing; Part II
AGENCY: Internal Revenue Service, Department of the Treasury.
ACTION: Notice of proposed rulemaking.
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SUMMARY: The Department of the Treasury (Treasury Department) and
Internal Revenue Service (IRS) are proposing regulations that provide
for a federal independent dispute resolution (IDR) process to permit
group health plans and nonparticipating providers, facilities, and
providers of air ambulance services to determine the out-of-network
rate for items and services that are emergency services, nonemergency
services furnished by nonparticipating providers at participating
facilities, and air ambulance services furnished by nonparticipating
providers of air ambulance services, under certain circumstances.
Elsewhere in this issue of the Federal Register, the IRS is issuing the
temporary regulations that correspond to this proposal at the same time
that the Office of Personnel Management (OPM), the Employee Benefits
Security Administration of the Department of Labor (DOL), and the
Center for Medicare & Medicaid Services of the Department of Health and
Human Services (HHS) are issuing substantially similar interim final
rules with request for comments. The text of those temporary
regulations also serves as the text of these proposed regulations.
DATES:
Comment date: To be assured consideration, comments must be
received at one of the addresses provided below, no later than 5 p.m.
on December 6, 2021.
Applicability date: It is proposed that these regulations apply for
plan years beginning on or after January 1, 2022.
ADDRESSES: In commenting, please refer to file code REG-107707-21.
Comments, including mass comment submissions, must be submitted in one
of the following two ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to <a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the ``Submit a
comment'' instructions.
2. By mail. You may mail written comments to the following address
ONLY: Office of Health Plan Standards and Compliance Assistance,
Employee Benefits Security Administration, U.S. Department of Labor,
200 Constitution Avenue NW, Room N-5653, Washington, DC 20210,
Attention: RIN 1210-AB00.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
FOR FURTHER INFORMATION CONTACT: Kari DiCecco, (202) 317-5500, Internal
Revenue Service, Department of the Treasury.
SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments
received before the close of the comment period are available for
viewing by the public, including any personally identifiable or
confidential business information that is included in a comment. We
post all comments received before the close of the comment period on
the following website as soon as possible after they have been
received: <a href="http://regulations.gov">http://regulations.gov</a>. Follow the search instructions on
that website to view public comments.
Background and Regulatory Impact Analysis
The Treasury Department and the IRS propose to amend paragraphs
(a), (c), (d), and (g) of Sec. 54.9815-2719 of the Miscellaneous
Excise Tax Regulations to expand the scope of claims eligible for
external review to include adverse benefit determinations related to
compliance with the surprise billing and cost-sharing protections under
the No Surprises Act.
The Treasury Department and the IRS also propose to add Sec. Sec.
54.9816-8 and 54.9817-2 to establish a federal IDR process that
nonparticipating providers or facilities, nonparticipating providers of
air ambulance services, and group health plans may use following the
end of an unsuccessful open negotiation period to determine the out-of-
network rate for certain services.
The temporary regulations published elsewhere in this issue of the
Federal Register add Sec. Sec. 54.9815-2719T, 54.9816-8T, and 54.9817-
2T. The proposed and temporary regulations are being published as part
of a joint rulemaking with the OPM, DOL, and HHS. The text of temporary
sections added elsewhere also serves as the text of the corresponding
sections proposed
[[Page 55757]]
in this document. The preamble to the temporary regulations contains
the agency's rationale and provides a regulatory impact analysis.
Drafting Information
The principal author of this notice of proposed rulemaking is Kari
DiCecco, Office of Associate Chief Counsel (Employee Benefits, Exempt
Organizations and Employment Taxes). The proposed regulations, as well
as the temporary regulations, have been developed in coordination with
personnel from the OPM, DOL, and HHS.
List of Subjects in 26 CFR Part 54
Excise taxes, Pensions, Reporting and recordkeeping requirements.
Proposed Amendments to the Regulations
Accordingly, 26 CFR part 54 is proposed to be amended as follows:
PART 54--PENSION EXCISE TAXES
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Paragraph. 1. The general authority citation for part 54 continues to
read as follows:
Authority: 26 U.S.C. 7805, unless otherwise noted.
* * * * *
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Par. 2. Section 54.9815-2719 is amended by revising paragraphs (a),
(c), (d), and (g) to read as follows:
Sec. 54.9815-2719 Internal claims and appeals and external review
processes.
[The text of proposed Sec. 54.9815-2719(a), (c), (d), and (g) is
the same as the text of Sec. 54.9815-2719T(a), (c), (d), and (g)
published elsewhere in this issue of the Federal Register].
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Par. 3. Section 54.9816-1 is added to read as follows:
[The text of proposed Sec. 54.9816-1 is the same as the text of
Sec. 54.9816-1T published elsewhere in this issue of the Federal
Register].
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Par. 4. Section 54.9816-2(a) and (b) is added to read as follows:
[The text of proposed Sec. 54.9816-2(a) and (b) is the same as the
text of Sec. 54.9816-2T(a) and (b) published elsewhere in this issue
of the Federal Register].
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Par. 5. Sections 54.9816-8 and 54.9817-2 are added to read as follows:
Sec. 54.9816-8 Independent dispute resolution process.
[The text of proposed Sec. 54.9816-8 is the same as the text of
Sec. 54.9816-8T published elsewhere in this issue of the Federal
Register].
Sec. 54.9817-2 Independent dispute resolution process for air
ambulance services.
[The text of proposed Sec. 54.9817-2 is the same as the text of
Sec. 54.9817-2T published elsewhere in this issue of the Federal
Register].
Douglas W. O'Donnell,
Deputy Commissioner for Services and Enforcement.
[FR Doc. 2021-21419 Filed 9-30-21; 4:15 pm]
BILLING CODE 4830-01-P
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