On December 27, 2020, President Trump signed into law the $2.3 trillion Consolidated Appropriations Act of 2021 (CAA), which funds the government for the next nine months and also includes $900 billion in stimulus funding in response to the ongoing COVID-19 pandemic and its impact on various sectors of the economy. This update will summarize the surprise medical billing provision in the No Surprises Act, a section of the law that is designed to protect health plan members from balance-billing by out-of-network (OON) providers under certain circumstances.
Effective on January 1, 2022, the No Surprises Act law will cap a plan member’s cost-sharing obligations for OON services to the plan’s applicable in-network cost-sharing level for the following three categories of services:
The law does contain a limited exception to the balance billing prohibition for non-emergency service providers performed by OON providers at in-network facilities. Those providers may balance-bill a member if all of the following conditions are met:
States are also permitted to impose other OON provider requirements that go beyond the federal requirements, and it remains to be seen how many states enact more stringent requirements. The law directs the U.S. Department of Health and Human Services (HHS) to propose regulations to enact the No Surprises Act by July 1, 2021. We will provide further updates when regulations are finalized.
The following links will be helpful to those seeking more information:
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