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OPM, HHS Move to End Surprise Medical Billing, and More

A weekly roundup of pay and benefits news.

The Office of Personnel Management and the Health and Human Services Department are set to implement new regulations to bar insurers, including carriers on the Federal Employees Health Benefits Program, from engaging in surprise medical billing.

Surprise medical billing most often occurs when a patient goes to an in-network hospital, but receives care from a physician who is out of network. The practice was banned by the No Surprises Act, which was signed into law as part of the fiscal 2021 omnibus appropriations bill last December.

In an interim final rule set to be published in the Federal Register Thursday, OPM and HHS, as well as the Labor and Treasury departments, moved to implement that law’s provisions.

The rule bans, for both FEHBP participants and people covered by group health plans and other insurance programs, surprise billing for emergency services, mandating that hospital services must be treated on an in-network basis. And it bans insurance companies from charging out-of-network rates for ancillary care, like anesthesiology, at an in-network facility.

It also bans “high out-of-network” cost-sharing, including co-insurance and deductibles, for both emergency and non-emergency services. Under the regulations, patient cost-sharing for out-of-network doctors cannot be higher than if those services were provided by an in-network doctor. And it requires health care providers to obtain patients’ consent for care that will be billed as out-of-network before the provider can bill at the higher out-of-network rate.

“Facing a difficult medical situation is challenging enough—no one should then face a surprise medical bill when they get home,” said OPM Director Kiran Ahuja in a statement. “This interim rule helps to protect Americans from financial ruin and honors federal employees, retirees, their covered family members and other enrollees who receive health care through the FEHB Program, the largest employer-sponsored plan, by giving them new protections from unexpected medical bills.”

Regulations impacting health care providers will take effect Jan. 1, 2022, while for insurance providers, including the FEHBP, they will be effective for the first full contract years beginning on or after Jan. 1.

Catch-Up FERS Contributions for Former Temps

A bipartisan group of lawmakers last week introduced a bill that would provide federal employees who began their careers as temporary workers an opportunity to “buy back” their service time before they received permanent positions for the purposes of defined benefit retirement calculations.

The Federal Retirement Fairness Act, introduced by Reps. Derek Kilmer, D-Wash., and Tom Cole, R-Okla., would allow employees in the Federal Employees Retirement System who first entered government under temporary appointments to make catch-up contributions to cover the time they were temps and unable to contribute to their retirement accounts.

A similar provision was once in place for employees enrolled in the Civil Service Retirement System, but was phased out after FERS was implemented in 1989. Now, the bill’s proponents say, these federal employees often must choose between retiring with a lower defined benefit pension, or working additional years to make up the difference.

“Many federal employees begin their careers in temporary positions before transitioning to permanent status—so we need to have their backs,” Kilmer said in a statement. “This bill will ensure that all federal workers . . . have the opportunity to retire on time, regardless of how they started their careers.”