No Surprises Act 2022
According to the FTC, "The No Surprises Act seeks to protect consumers from surprise medical bills arising out of certain out-of-network emergency care. Under Section 109 of the Act, the Secretary of Health and Human Services (HHS), in consultation with the FTC and the Attorney General, must conduct a study by January 1, 2023, and annually thereafter for each of the following 4 years, on the effects of the Act on any patterns of vertical or horizontal integration of health care facilities, providers, group health plans, or health insurance issuers; overall health care costs; and access to health care."
Actual text of the law (starting on page 1577).
According to the APA, "the purpose of this legislation is to ensure that patients are not surprised by an unexpected bill from their healthcare provider. The No Surprises Act will ensure transparency for patients receiving in good faith the cost of services before the services are rendered. This legislation goes into effect January 2022. It aims to prevent patients from receiving an unexpected bill without having the opportunity to select an in-network or out-of-network provider/facility prior to services being rendered (Noyes, 2021).
"More details, regulations, and resources are forthcoming by the government as it specifically pertains to Behavior Healthcare Providers. However, some of the key takeaways of the No Surprises Act include the following (American Hospital Association, 2021):
(1) Protects patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities, including by air ambulances.
(2) Holds patients liable only for their in-network cost-sharing amount, while giving providers and insurers an opportunity to negotiate reimbursement.
(3) Allows providers and insurers to access an independent dispute resolution process in the event disputes arise around reimbursement. The legislation does not set a benchmark reimbursement amount.
(4) Requires both providers and health plans to assist patients in accessing health care cost information
"Please see the following sources and resources for more information. As [UMHCA] becomes aware of additional details, we will keep you informed."
More helpful resources:
Download a sample "No Surprises Act" PDF. Please note that this is provided as a SAMPLE template and that UMHCA does not endorse one particular means of implementing this for your business, agency, center, or private practice.
American Hospital Association. (2021, January 14). Detailed summary of no surprises act - aha. https://www.aha.org/system/files/media/file/2021/01/detailed-summary-of-no-surprises-act-advisory-1-14-21.pdf
Ending surprise medical bills. CMS.gov Center for Medicare and Medicaid Services. (n.d.). https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills
Noyes, K. (2021, October 19). Surprise! it's the no surprises act. The National Law Review. https://www.natlawreview.com/article/surprise-it-s-no-surprises-act