A federal law enacted in December 2020 as part of the Consolidated Appropriations Act, 2021 (CAA-21) that imposes extensive requirements regarding surprise medical billing for group health plans, health insurers, and health care providers and facilities (Pub. L. No. 116-260).

Under the NSA, employer-sponsored group health plans and health insurers must adopt protections against balance billing and out-of-network (OON) cost-sharing regarding:

Additionally, OON health providers, health care facilities, and providers of air ambulance services are prohibited from balance-billing plan participants and beneficiaries in certain situations, unless the NSA's notice and consent requirements are met (see Practice Note, Surprise Medical Billing for Providers and Facilities: Overview).

Regarding payments for services by OON providers, the NSA includes open negotiation and independent dispute resolution (IDR) procedures for use by plans or insurers and OON providers to determine the payment amount (see Practice Note, Surprise Medical Billing for Group Health Plans: Independent Dispute Resolution (IDR) Process and Practice Note, Surprise Medical Billing for Providers and Facilities: Independent Dispute Resolution Process).

For additional compliance resources regarding the NSA, see Surprise Medical Billing for Health Plans, Health Insurers, and Health Care Providers and Facilities Toolkit.