Our employee benefits team recently published a LawFlash discussing the Consolidated Appropriations Act, 2021, which contains provisions impacting employer sponsored group health plans, including to protect group health plan participants from surprise medical bills, ensure health plan price transparency, and offer relief related to health and dependent care flexible spending accounts.
Within the act is the No Surprises Act, which prohibits certain surprise medical billing, and may be of particular interest to our healthcare industry readers.
In summary, the No Surprises Act does the following:
- Prohibits balance billing participant by an out-of-network provider for services received at an in-network facility, unless the out-of-network provider gives notice to the participant and the participant consents. The consent rules are narrowly drafted and require consent to be given at least 72 hours prior to receiving treatment.
- Requires coverage of emergency services at in-network rates and without prior authorization. Prohibits out-of-network air ambulances from charging participants more than the in-network cost-sharing amounts for their services.
- Requires a 30-day open negotiation period for group health plans and issuers to settle out-of-network claims with providers, including out-of-network air ambulance claims.
- Establishes an “Independent Dispute Resolution” process (i.e., binding arbitration) for plans/issuers and out-of-network providers who cannot agree on a rate during the open negotiation period.