What You Need to Know
- Many No Surprises Act provisions take effect Jan. 1, 2022.
- The law applies mainly to enrollees in self-insured plans.
- One worry is patient notice form overload.
The American Hospital Association (AHA) was happy to see the federal No Surprises Act become law, but implementing and applying the act could be a challenge.
Molly Smith, group vice president for public policy at the AHA, talked about the new anti-surprise billing law during a panel discussion Tuesday, at the AHIP National Health Policy Conference for 2021.
The No Surprises Act is part of the Consolidated Appropriations Act, 2021, package, which former President Donald Trump signed Dec. 27, 2020.
It includes many provisions designed to protect people from getting big bills for care from expensive, out-of-network providers at in-network hospitals, big bills from out-of-network emergency care providers, and out-of-network air ambulance services providers.
States typically impose anti-surprise billing rules on health insurers that are working with doctors and hospitals that have patients with insurance from an insurance company. States can’t regulate surprise billing at self-funded employer health plans. The new federal law will apply mainly to employers’ self-funded health plans, Smith said at the AHIP conference, which was presented through the web.
One concern is about a section of the law that requires health plans and out-of-network providers that disagree about charges for care to go through arbitration.
Smith wondered whether the arbitration process will be predictable enough to minimize the need for hospitals to spend time and money actually going through with it.