IRS sets health plan factor under No Surprises Act


The IRS recently published Rev. Proc. 2022-11, providing the combined percentage increase that group health plans or group or individual health insurance issuers must use for calculating qualifying payment amounts. The combined percentage increase for 2022 is 1.0648523983, and any resulting qualifying payment amount may be rounded to the nearest dollar.

This procedure is issued in accordance with the No Surprises Act of 2021, which was enacted as part of the Consolidated Appropriations Act, 2021, and provides protections against certain surprise medical bills when patients unexpectedly receive out-of-network health care.

Interim final regulations issued in July 2021, implementing new Sections 9816 and 9817 of the Code, in conjunction with the No Surprises Act, generally provide that a patient’s cost-sharing amount generally must be based on the qualifying payment amount. The combined percentage increase is for items and services provided on or after Jan. 1, 2022, and before Jan. 1, 2023.





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