Federal Laws

Find out what rights you and your patients have under current federal statutes and regulations, such as the Employee Retirement Income Security Act and the Medicare Advantage program.

Federal Law

Title 42-The Public Health And Welfare-Chapter 6A-Subchapter XXV-Part E. Health Care Provider Requirements

08/30/2023 42 USC Sections 300gg–131, 300gg–132, 300gg–133, 300gg–134, 300gg–135, 300gg–136, and 300gg–137

Balance billing in cases of emergency services; Balance billing in cases of non-emergency services performed by nonparticipating providers at certain participating facilities; Provider requirements with respect to disclosure on patient protections against balance billing; Enforcement; Air ambulance services; Provision of information upon request and for scheduled appointments; Patient-provider dispute resolution

OON-Payment Issues
Federal Law

Title 42-Chapter 7-Subchapter XVIII-Part C. Medicare+Choice Program

08/30/2023 42 USC Section 1395w-26

Establishment of standards

Preemption-Medicare Advantage
Federal Law

Title 42-Chapter 7-Subchapter XVIII-Part C. Medicare+Choice Program

08/30/2023 42 USC Section 1395w-22

Benefits and beneficiary protections

Anti-gag clause-Med. Adv., Directories-Med. Adv., Liability-insurer shifting to physician-Med. Adv., Med. Adv.-Med. Nec. Appeals-Deadlines, Med. Adv.-Med. Nec. Decisions-Deadlines, Network Adequacy-Med. Adv., Prohibited financial incentives-Med. Adv., Risk-Physicians Taking-Med. Adv.
Federal Law

Title 45-Subtitle A-Subchapter B-Part 156-Subpart C. Qualified Health Plan Minimum Certification Standards

08/30/2023 45 CFR 156.235

Essential community providers

Network Adequacy-Fed. Exchange Reg.
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart C. Benefits and Beneficiary Protections

08/30/2023 42 CFR 422.116

Network adequacy

Network Adequacy-Med. Adv.
Federal Law

Title 26-Internal Revenue Code-Subtitle K-Chapter 100-Suchapter B. Other requirements

08/30/2023 26 USC Sections 9816 and 9817

Preventing surprise medical bills; Ending surprise air ambulance bills

OON-Payment Issues
Federal Law

Title 26-Internal Revenue Code-Subtitle K-Chapter 100-Suchapter B. Other requirements

08/30/2023 26 USC Section 9818

Continuity of care

Continuity of Care Post-Contract
Federal Law

Title 26-Internal Revenue Code-Subtitle K-Chapter 100-Suchapter B. Other requirements

08/30/2023 26 USC Section 9820

Protecting patients and improving the accuracy of provider directory information

Directories