ABSTRACT

No Surprises Act's Independent Dispute Resolution Process and Related Litigation [April 1, 2022]   [open pdf - 701KB]

From the Document: "On December 27, 2020, the No Surprises Act (NSA), part of the Consolidated Appropriations Act, 2021 (P.L. 116-260), was enacted to address 'surprise billing' [hyperlink] (i.e., circumstances where individuals receive large, unexpected medical bills when they are unknowingly, and potentially unavoidably, treated by out-of-network providers). Surprise billing is rooted in most private insurers' use of provider networks, which generally results in consumers paying more for out-of-network care [hyperlink] (relative to the same in-network care). The NSA established federal surprise billing requirements [hyperlink] with respect to out-of-network emergency services, out-of-network nonemergency services provided during a visit at an in-network facility, and out-of-network air ambulance services. In these situations and for plan years beginning on or after January 1, 2022, the NSA generally limits the amount consumers pay for care and specifies a methodology used to determine how much insurers must pay providers for care, including the use of an independent dispute resolution (IDR) process. Taken together, these requirements effectively result in the provider and insurer recognizing the same total price for care. This Insight provides an overview of the NSA's IDR process; the Departments of Health and Human Services, Labor, and the Treasury's (tri-agencies') implementation of these requirements; and related litigation."

Report Number:
CRS Insight, IN11906
Author:
Publisher:
Date:
2022-04-01
Copyright:
Public Domain
Retrieved From:
Congressional Research Service: https://crsreports.congress.gov/
Format:
pdf
Media Type:
application/pdf
URL:
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