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CHA Issues Summary of No Surprises Act Surprise Billing Legislation

For CEOs, CFOs, government relations executives, finance & reimbursement staff, legal counsel

CHA has issued a summary of the No Surprises Act, which was signed into law on Dec. 27, 2020, as part of the Consolidated Appropriations Act of 2021. The No Surprises Act addresses surprise medical billing at the federal level, with most sections of the legislation effective Jan. 1, 2022. The Departments of Health and Human Services, Treasury, and Labor will issue regulations and guidance to implement numerous provisions.  

The detailed summary, which provides a section-by-section outline of the legislation’s key provisions, includes information about: 

  • Limiting patient out-of-pocket costs to the in-network amount for emergency medical care provided by out-of-network facilities and providers 
  • Limiting patient out-of-pocket costs to the in-network amount in certain situations where care is delivered at an in-network facility by an out-of-network provider  
  • Establishing an independent dispute resolution process to determine the amount plans will pay non-contracted facilities and providers in covered situations 
  • Placing requirements on plans, facilities, and providers to provide patients with an advanced explanation of benefits for scheduled services