The No Surprises Act for 2022 Plan Years
The December 2020 Consolidated Appropriations Act (CAA) included a ban on ‘surprise’ medical bills effective with plan years commencing in 2022. The Agencies have issued an interim final rule to implement this law. The Congressional Research Services have also issued a report to outline the ways the No Surprise Act will impact employer health plans.
Many states have already passed similar bans on out of network surprise bills under certain circumstances. The federal law tracks many of the same provisions. The main areas in which the new law will prohibit balance bills, or surprise bills, are as follows:
Out-of-network emergency services
Out-of-network services during an outpatient observation stay or an inpatient or outpatient stay during emergency services
Out-of-network non-emergency services provided at an in-network facility
Out-of-network air ambulance services
Services scheduled at least three business days in advance
Out-of-network services from a provider that initially was in-network but subsequently became out-of-network during treatment
Out-of-network services from a provider that the individual believed was in-network based on incorrect information from the plan or provider
The new law will prohibit patient surprise bills by “establishing new requirements on insurers and providers to create a degree of consumer protection related to reducing patient financial responsibilities with respect to some types of out-of-network care and/or by providing consumers with information so they can make an informed decision about whether to receive scheduled out-of-network care.”
The insurance carrier will make an initial payment to the provider in the above listed service situations, and the provider may then request a negotiation to debate the payment amount. Independent dispute resolution is available for such disputes when a settlement amount cannot be reached between the provider and insurer. The ultimate goal of this new law is to remove the patient from these billing disputes, and require providers to accept the resolution reached in these situations.
The full text of the Congressional Research report can be viewed here.