Surprise Medical Billing for Health Plans, Health Insurers, and Health Care Providers and Facilities Toolkit | Practical Law

Surprise Medical Billing for Health Plans, Health Insurers, and Health Care Providers and Facilities Toolkit | Practical Law

A collection of resources addressing surprise medical billing requirements under the No Surprises Act (NSA), which was enacted in December 2020 as part of the Consolidated Appropriations Act, 2021 (CAA-21). The NSA imposes extensive federal requirements regarding surprise medical billing for group health plans, health insurers, and health care providers and facilities. The NSA has been the topic of significant implementing guidance and related litigation.

Surprise Medical Billing for Health Plans, Health Insurers, and Health Care Providers and Facilities Toolkit

by Practical Law Employee Benefits & Executive Compensation and Practical Law Health Care
MaintainedUSA (National/Federal)
A collection of resources addressing surprise medical billing requirements under the No Surprises Act (NSA), which was enacted in December 2020 as part of the Consolidated Appropriations Act, 2021 (CAA-21). The NSA imposes extensive federal requirements regarding surprise medical billing for group health plans, health insurers, and health care providers and facilities. The NSA has been the topic of significant implementing guidance and related litigation.
Enacted in December 2020, the No Surprises Act (NSA), part of the Consolidated Appropriations Act, 2021 (CAA-21), added extensive federal requirements regarding surprise medical billing for group health plans, health insurers, and health care providers and facilities (Pub. L. No. 116-260 (Dec. 27, 2020)). The NSA's requirements provide protections for plan participants/patients regarding surprise medical billing practices for emergency services and other situations where individuals may otherwise incur large, unexpected medical bills.
The NSA's requirements for plans, insurers, and providers, which generally became effective beginning in January 2022, are amendments to:
Beginning in 2021, the Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (collectively, Departments) implemented the NSA's requirements by issuing proposed and final regulations, model notices, and other guidance. This guidance has included:
As noted, the Departments' surprise billing have become the topic of legal challenges—many brought by health providers. In February 2023, for example, a Texas district court invalidated certain portions of the Departments' August 2022 final regulations addressing the federal IDR process (Tex. Med. Ass'n v. HHS, (E.D. Tex. Feb. 6, 2023); see Legal Update, Texas District Court Once Again Vacates Departments' No Surprises Act Regulations). Regarding more recent surprise billing litigation and related developments, see Legal Updates:
The NSA's requirements impose substantial compliance burdens on health plans, insurers, providers, and facilities, which, because of the January 2022 effective date, required initial implementation on a compressed timetable. Due to ever-changing regulatory guidance and recent litigation, the NSA's requirements also require ongoing monitoring and updates to surprise billing-related procedures. This includes monitoring the status of the federal IDR portal for surprise billing payment determinations, which the Departments have closed at various times in response to litigation outcomes.
This Toolkit includes a collection of resources to help health plans, insurers, providers, and facilities comply with the NSA's requirements for surprise medical billing.