The No Surprises Act is federal legislation passed in early 2021 directing The Centers for Medicare and Medicaid (CMS) to make rules providing a federal solution to the problem of “surprise billing.”
CMS' No Surprises Act rules formally went into effect January 1, 2022, although they are applying "enforcement discretion" through the end of the year.
There are three rules comprising the package broken up in "parts". Part I applies to hospitals and ambulatory surgical centers while Part II applies to all state-licensed providers and facilities, which may include certified behavioral health providers.
Part II requirements include:
Establishing an independent dispute resolution process to determine out-of-network payment amounts between providers (including air ambulance providers) or facilities and health plans.
Requiring good-faith estimates of medical items or services for uninsured (or self-paying) individuals.
Establishing a patient-provider dispute resolution process for uninsured (or self-paying) individuals to determine payment amounts due to a provider or facility under certain circumstances.
Providing a way to appeal certain health plan decisions
The final part, Part III, implements new requirements for group health plans and issuers to submit certain information about prescription drug and health care spending.
For more information about the rules, including rule fact sheets, provider resources, and more, Please visit CMS' No Surprises site.