Balance Billing and Other No Surprises Act Rules

Summary

This practice note discusses the principal provisions of the No Surprises Act, enacted as Title I of Division BB of the Consolidated Appropriations Act, 2021 (CAA) (Pub. L. No. 116-260), including balance billing and reimbursement rate rules for group health plans and health insurance issuers in the context of certain healthcare services performed by nonnetwork providers. Among other things, for certain services, these rules prohibit surprise billing of participants, constrain participant cost-sharing obligations, and establish a mandatory negotiation and arbitration process to resolve reimbursement rate disputes between the plan or issuer and the service provider. Other important provisions impose continuity of care at in-network rates for certain patients when a provider leaves a network and provide for a right to external review of adverse determinations for claims subject to the balance billing protections.