Administration Issues First Rule on the No Surprises Act

On July 1, the Administration issued a first set of rules implementing the聽No Surprises Act. The statute and rules target the all-too-common problem of surprise or balance billing. Surprise billing can happen when a patient inadvertently gets services from an out-of-network (OON) health care provider. Maybe the patient was taken to an OON hospital for emergency care 鈥 or maybe the patient sought treatment at an in-network hospital, but unwittingly received care from one or more OON providers. Either way, the patient ends up on the hook for outsize, unexpected charges. With millions of Americans affected by surprise medical billing, patient and consumer advocates waged a years鈥 long effort to win passage of the No Surprises Act.

The new rule takes a first step toward implementing the Act鈥檚 protections. Beginning in 2022, patients will be protected from charges over and above their regular in-network cost sharing when they receive emergency care at OON facilities, or when they receive non-emergency services from OON providers working at in-network facilities. The rule also establishes a framework for determining reimbursement rates from insurers to OON providers. And the rule spells out notice and consent requirements that OON providers must follow before treating or billing patients 鈥 as well as creating a complaint system for consumers who think they were wrongly billed.

The new rule doesn鈥檛 resolve all aspects of the surprise billing problem. In coming months, federal agencies will undertake further rulemaking on how to resolve reimbursement disputes between insurers and OON health care providers. Agencies will also address air ambulance billing in separate rulemaking. Ground ambulance services (not covered by the No Surprises Act) will unfortunately continue to generate surprise medical bills for some patients. 聽Even with these limitations, the surprise billing protections contained in the No Surprises Act will help millions and constitute a major consumer victory.

Quick hits:

  • As previously reported, the American Rescue Plan (enacted in March 2021) creates new opportunities to save money on ACA health insurance. had to re-engineer its systems to implement some of the new benefits. Effective July 1, the enhanced subsidies 鈥 $0 premiums for people who received unemployment insurance benefits at any point in 2021 鈥 are now available. Check out this joint HFA-NHF video explaining the ARP law, and visit to enroll or update your application if you are eligible for the new subsidies.
  • On July 28, U.S. Senators voted 67-32 to advance the Biden Administration鈥檚 $1 trillion bipartisan infrastructure bill. (The vote marks only the first step toward passage of the bill, allowing debate to begin.) This bill mainly focuses on physical infrastructure: e.g., roads, bridges, drinking water, and internet. Lawmakers will try to include major health reforms in an expected second infrastructure package. Priorities for a second bill might include: including dental/vision/hearing benefits in Medicare, restructuring the Medicare Part D drug benefit, closing the Medicaid coverage gap, extending the enhanced subsidies for ACA plans beyond 2022, and more.
  • On July 22, HHS issued an informational bulletin to state Medicaid and CHIP agencies reaffirming that the 2019 public charge rule is no longer in effect. HHS reiterated that eligible immigrants鈥 use of Medicaid and other public benefits will not count against them when determining their immigration status. HHS urged state agencies to assist in disseminating this message.
  • Also on July 22, the Missouri Supreme Court unanimously upheld as constitutional the state鈥檚 voter-approved Medicaid expansion. Earlier this year, the Missouri Legislature had refused to provide funding for the state鈥檚 Medicaid expansion, notwithstanding the fact that coverage was supposed to go into effect on July 1, 2021. Three plaintiffs, people who would be聽eligible for Medicaid coverage under the voter-passed Medicaid expansion, sued the stateDepartment of Social Services, seeking a ruling that would allow them to enroll and receive benefits. HFA and 21 other advocacy groups submitted an amicus curiae brief in support of Medicaid expansion. Following the Missouri Supreme Court鈥檚 ruling, the matter has been returned to the trial court for instructions on how the state should move forward with implementation.
  • HHS Secretary Xavier Becerra officially renewed the determination that COVID-19 constitutes a national public health emergency. As HFA has previously reported, the U.S. federal government is providing enhanced funding for state Medicaid programs for the duration of the public health emergency 鈥 and state Medicaid programs are restricted from disenrolling beneficiaries so long as they accept such funding.
  • HFA together with other patient advocacy groups submitted multiple comment letters in July, calling on federal and state lawmakers to: protect consumers against copay accumulator adjusters; provide permanent funding for the Children鈥檚 Health Insurance Program; advance health equity across government programs; revoke Tennessee鈥檚 controversial block grant waiver; and reinforce ACA guardrails against non-compliant forms of health coverage.



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