No Surprises Act

In December 2020, Congress passed the No Surprises Act as part of a larger spending and COVID-19 aid package. Throughout 2021, the Department of Health and Human Services (HHS), Department of Labor (DOL) and the US Department of Treasury (USDT) will be deciding on the rules and regulations to implement the No Surprises Act.

  • Twitter

The No Surprises Act was passed late December 2020 as part of H.R. 133, a $900 billion COVID-19 relief package to address surprise medical billing at the federal level. The No Surprises Act (NSA) was a major step in tackling the issue that has been plaguing patients, physicians and lawmakers alike for many years. Patients will only be responsible for paying the in-network cost-sharing rate for medical services, which may include their insurance deductible, co-insurance and co-payments.


The NSA is a positive step in taking patients out-of-the middle of payment disputes that can occur between health insurers and providers (e.g., hospitals, health systems, clinics, medical staff agencies) for medical services. Grassroots Emergency Medicine believes that overall, the legislation represents a reasonable approach to addressing the issue of surprise medical bills and will protect patients from out-of-network bills. However, while the No Surprises Act places a framework for addressing Surprise Billing and includes a provision for an independent dispute resolution (IDR), there are numerous aspects of implementation that are left to be decided through rules and regulations from the Department of Health and Human Services (HHS), Labor (DOL) and Treasury (USDT). The rules and regulations made by these Departments will ultimately determine whether the No Surprises Act is implemented as a fair, patient-friendly solution that protects access to quality medical care and the emergency safety net or a surreptitious hand out to the powerful and egregiously profitable health insurance companies.


The legislation will become effective January 1, 2022 and the rules and regulations will be determined in a stage-wise approach by the Departments over the next year. The No Surprises Act Timeline illustrates key timeframes that decisions will be made.


Emergency physicians must continue to engage with the Departments and Congress to ensure the NSA’s rules and regulations protect patients, and the emergency medicine safety net and access to quality medical care is not undermined. Staying vigilant and continuing advocacy on this issue is vital and will help determine whether the No Surprises Act results in an A+ solution to surprise medical billing or another flawed, insurer friendly legislative affair.


More information on the No Surprises Act:


Important SMB Status Update from ACEP


High-Level Summary by the AMA


Detailed Summary by the American Hospital Association.


Surprise Billing Protections take effect next year, Tips to prepare now.