No Surprises Act

No Surprises Act

No Surprises Act Industry Altering
Legislation or Ill-Fated Attempt?  

BY MARIDY MCGINNIS, CEO

 

The No Surprises Act (NSA)

A collection of three interim final rules that apply to the plan year beginning January 1, 2022, provides Federal protections against surprise billing, places limits on Out-of-Network (OON) costs and establishes new disclosure requirements for all group and individual health plans.

  • Interim final rule #1: Prohibits surprise billing for emergency care including air-ambulance services and restricts the use of surprise billing for non-emergency care
  • Interim final rule #2: Requires all OON providers to issue a Good-Faith Estimate (GFE) for goods/services, requires insurers to provide an Advanced Explanation of Benefits (AEOB) notice, establishes an Independent Dispute Resolution (IDR) process for disputed payments, and expands members’ rights to external appeal
  • Interim final rule #3: Implements new reporting requirements for insurers and health plans on prescription drug spending

With the first interim final rule being based…

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