Detailed Summary of No Surprises Act

AHA Legislative Advisory
January 14, 2021

Comprehensive Legislation to Address Surprise Medical Billing at the Federal Level

 

At a Glance

The Issue:

On Dec. 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB – Private Health Insurance and Public Health Provisions). The No Surprises Act addresses surprise medical billing at the federal level. Most sections of the legislation go into effect on Jan. 1, 2022, and the Departments of Health and Human Services, Treasury, and Labor are tasked with issuing regulations and guidance to implement a number of the provisions.

Our Take:

The hospital and health system field strongly supports protecting patients from surprise medical bills. The AHA is pleased that Congress rejected approaches that would impose arbitrary rates on providers, which could have significant consequences far beyond the scope of surprise medical bills and impact access to hospital care. We also applaud Congress for rejecting attempts to base rates on public payers, including Medicare and Medicaid, which historically pay far less than the cost of delivering care. We believe this legislation is an important step forward in protecting patients.

What You Can Do:

Review this advisory and share it with your senior management team and hospital staff.

Further Questions:

If you have questions, please contact AHA at 800-424-4301.

Key Takeaways

Among many other provisions, the No Surprises Act:

  • Protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities, including by air ambulances.
  • Holds patients liable only for their in-network cost-sharing amount, while giving providers and insurers an opportunity to negotiate reimbursement.
  • Allows providers and insurers to access an independent dispute resolution process in the event disputes arise around reimbursement. The legislation does not set a benchmark reimbursement amount.
  • Requires both providers and health plans to assist patients in accessing health care cost information.

Related Resources

Special Bulletin
Member
The Departments of Health, Treasury and Labor (collectively, “the departments”) today opened the federal Independent Dispute Resolution (IDR) portal as…
Letter/Comment
Public
: Letter with comments to CMS on the burden estimates associated with the delivery of good faith estimates to uninsured and self-pay patients and the patient-…
Special Bulletin
Member
A federal judge in Texas last night struck down certain parts of the federal government’s surprise medical billing regulations related to the arbitration…
Fact Sheets
Public
More than 24 months after the first cases of COVID-19 were reported in the U.S., the pandemic has afflicted millions of people across the country has imposed…
Special Bulletin
Member
Effective Jan. 1, 2022, facilities and providers must adhere to several new policies required by the No Surprises Act.
Frequently Asked Questions (FAQs)
Member
A collection of frequently asked questions on the uninsured and self-pay good faith estimates, required as part of the No Surprises Act.