The federal No Surprises Act (the “Act”) was enacted in 2020 in order to protect patients from surprise medical bills. The Act creates requirements for group health plans and health insurance issuers, and also specifically for various health care providers, health care facilities (including hospitals, hospital outpatient departments, critical access hospitals, and ambulatory surgical centers), and providers of air ambulance services. The compliance requirements are effective on January 1, 2022, and some of the key provisions are as follows:
The Act prohibits “balance billing” for out-of-network emergency services, and for non-emergency services by nonparticipating providers at certain participating health care facilities, subject to certain notice and consent requirements.
The Act also requires provider and facility disclosures regarding the patient protections against balance billing, although a provider is not required to make such patient disclosures if the provider does not furnish items or services at a health care facility or in connection with visits at health care facilities, or to individuals to whom the provider furnishes items or services if such items or services are not furnished at a health care facility or in connection with a visit at a health care facility.
The Act establishes an independent dispute resolution (“IDR”) process for payors and providers to resolve disputes over provider payments.
The Act requires health care providers and health care facilities to inform their patients, orally and in writing, of the good faith estimate of treatment costs if the patient is not insured or covered by a federal health care plan under certain circumstances.
The federal Department of Labor has established a website that contains the laws and regulations regarding the Act, as well as sample forms. Here is a link:
The issue for New York providers is that New York already has an existing surprise bill law which is inconsistent with some of the federal provisions. In response, the New York Department of Financial Services has recently developed its own guidance regarding the implementation of the Act in New York. This guidance, in the form of Insurance Circular Letter No. 10 (December 17, 2021), can be found at the following link:
The Department of Financial Services has also developed a New York-compliant model form for providers to share with patients regarding some of the protections from surprise billing, which can be found here:
Lastly, although the Act is intended to take effect soon, some aspects of the Act (in particular the IDR provisions) are subject to various lawsuits across the country, all of which may impact the implementation and/or enforcement of the Act. In any event, it is important for all parties covered by the Act to develop applicable compliance policies and procedures.
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This Legal Briefing is intended for general informational and educational purposes only and should not be considered legal advice or counsel. The substance of this Legal Briefing is not intended to cover all legal issues or developments regarding the matter. Please consult with an attorney to ascertain how these new developments may relate to you or your business. © 2021 Law Offices of Pullano & Farrow PLLC