No Surprises Act - California Hospital Association (2024)

Background

On December 27, 2020, the No Surprises Act was signed into law 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 No Surprises Act prohibits balance billing for emergency services and in instances where health care services are received from an out-of-network provider at an in-network facility for federally regulated health insurance products. In instances covered by the Act, patient cost sharing is limited to the in-network amount. If a provider or facility is not satisfied with the initial payment from a health plan for out-of-network services covered by the Act, the provider or facility may attempt to negotiate a satisfactory payment with the plan. In instances where an appropriate amount cannot be negotiated, the provider or facility may submit the claim to an independent dispute resolution process to determine the appropriate payment amount. The law also requires providers and facilities to give patients a good faith estimate of expected charges for scheduled services or upon request.

CHA is providing resources to help members navigate the implementation of the No Surprises Act requirements.

Important dates:

• Jan. 1, 2022: Most provisions of the No Surprises Act go into effect for all hospitals, health systems, and health plans.

Resources