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Federal Register / Vol. 86, No. 131 / Tuesday, July 13, 2021 / Rules and Regulations
provider or the participating health care facility on behalf of the nonparticipating provider has obtained the services of a qualified interpreter to assist the individual with understanding the information contained in the notice and consent document.
g Scope of consent. The consent described in paragraph e of this section will constitute consent only to the receipt of the information provided pursuant to this section and will not constitute a contractual agreement of the participant, beneficiary, or enrollee to any estimated charge or amount included in such information, or to be treated by that provider or facility.
h Retention of certain documents. A
participating health care facility with respect to nonparticipating providers at such facility that obtains from a participant, beneficiary, or enrollee of a group health plan or group or individual health insurance coverage a written consent in accordance with paragraph e of this section, with respect to furnishing an item or service to such an individual, must retain the written notice and consent for at least a 7-year period after the date on which the item or service is so furnished. If a nonparticipating provider obtains a signed consent from a participant, beneficiary, or enrollee, where the facility does not otherwise obtain the consent on behalf of the provider, the provider may either coordinate with the facility to retain the written notice and consent for a 7-year period, or the provider must retain the written notice and consent for a 7-year period.
i Notification to plan or issuer. For each item or service furnished by a nonparticipating provider described in paragraph a of this section, the provider or the participating facility on behalf of the nonparticipating provider must timely notify the plan or issuer that the item or service was furnished during a visit at a participating health care facility, and, if applicable, provide to the plan or issuer a copy of the signed written notice and consent document described in paragraphs c and e of this section. In instances where, to the extent permitted by this section, the nonparticipating provider bills the participant, beneficiary, or enrollee directly, the provider may satisfy the requirement to notify the plan or issuer by including the notice with the bill to the participant, beneficiary, or enrollee.
j Applicability date. The provisions of this section are applicable with respect to items and services furnished during a plan year in the individual market, policy year beginning on or after January 1, 2022.

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149.430 Provider and facility disclosure requirements regarding patient protections against balance billing.

a In general. Each health care provider and health care facility including an emergency department of a hospital and an independent freestanding emergency department must make publicly available, post on a public website of such provider or facility if applicable, and provide to any individual who is a participant, beneficiary, or enrollee of a group health plan or group or individual health insurance coverage offered by a health insurance issuer and to whom the provider or facility furnishes items or services, the information described in paragraph b of this section regarding patient protections against balance billing, except as provided in paragraphs e and f of this section. A
provider or facility must make the disclosures in accordance with the method and timing requirements set forth in paragraphs c and d of this section.
b Content. The disclosures required under this section must include, in clear and understandable language, all the information described in this paragraph b and may include any additional information that does not conflict with that information.
1 A statement that explains the requirements of and prohibitions applicable to the health care provider or health care facility under sections 2799B1 and 2799B2 of the PHS Act and their implementing regulations in 149.410 and 149.420;
2 If applicable, a statement that explains any State law requirements regarding the amounts such provider or facility may, with respect to an item or service, charge a participant, beneficiary, or enrollee of a group health plan or group or individual health insurance coverage offered by a health insurance issuer with respect to which such provider or facility does not have a contractual relationship, after receiving payment, if any, from the plan or coverage, respectively, for such item or service and any applicable costsharing payment from such participant, beneficiary, or enrollee; and 3 A statement providing contact information for the appropriate State and Federal agencies that an individual may contact if the individual believes the provider or facility has violated a requirement described in the notice.
c Required methods for disclosing information. Health care providers and health care facilities must provide the disclosure required under this section as follows:

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1 With respect to the required disclosure to be posted on a public website, the information described in paragraph b of this section, or a link to such information, must appear on a searchable homepage of the providers or facilitys website. A provider or facility that does not have its own website is not required to make a disclosure under this paragraph c1.
2 With respect to the required disclosure to the public, a provider or facility must make public the information described in paragraph b of this section on a sign posted prominently at the location of the provider or facility. A provider that does not have a publicly accessible location is not required to make a disclosure under this paragraph c2.
3 With respect to the required disclosure to individuals who are participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a provider or facility must provide the information described in paragraph b of this section in a one-page doublesided notice, using print no smaller than 12-point font. The notice must be provided in-person or through mail or email, as selected by the participant, beneficiary, or enrollee.
d Timing of disclosure to individuals. A health care provider or health care facility is required to provide the notice to individuals who are participants, beneficiaries, or enrollees of a group health plan or group or individual health insurance coverage offered by a health insurance issuer no later than the date and time on which the provider or facility requests payment from the individual, or with respect to an individual from whom the provider or facility does not request payment, no later than the date on which the provider or facility submits a claim to the group health plan or health insurance issuer.
e Exceptions. A health care provider is not required to make the disclosures required under this section 1 If the provider does not furnish items or services at a health care facility, or in connection with visits at health care facilities; or 2 To individuals to whom the provider furnishes items or services, if such items or services are not furnished at a health care facility, or in connection with a visit at a health care facility.
f Special rule to prevent unnecessary duplication with respect to health care providers. To the extent a provider furnishes an item or service covered under the plan or coverage at a health care facility including an emergency
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