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

11/25/2024 42 USC Sections 300gg–131, 300gg–132, 300gg–133, 300gg–134, 300gg–135, 300gg–136, 300gg–137, 300gg–138 and 300gg–139

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; Continuity of care; Provider requirements to protect patients and improve the accuracy of provider directory information

Continuity of Care Post-Contract, Directories, OON-Payment Issues
Federal Law

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

11/21/2024 42 USC Section 1395w-26

Establishment of standards

Preemption-Medicare Advantage
Federal Law

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

11/21/2024 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

11/18/2024 45 CFR Section 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

11/14/2024 42 CFR Section 422.116

Network adequacy

Network Adequacy-Med. Adv.
Federal Law

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

11/25/2024 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

11/25/2024 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

11/25/2024 26 USC Section 9820

Protecting patients and improving the accuracy of provider directory information

Directories