This legislation was introduced during the last session of Congress; an amended version of the bill was signed into law on Dec. 27, 2020.The No Surprises Act establishes federal standards to protect patients from balance billing during emergency services for defined items and services provided by specified doctors, hospitals, and air ambulance carriers on an out-of-network basis. The federal law applies to individual, small group, and large group fully insured markets and self-insured group plans including grandfathered plans.The law applies to emergency services at out-of-network (OON) hospitals and free-standing emergency facilities, OON providers at in-network facilities, and OON air ambulance carriers. The No Surprises Act applies to three types of health care providers and facilities:
- Out-of-Network emergency covered items and services.
- Covered medical items and services performed by an out-of-network provider at an in-network hospital or emergency facility. Example: an out-of-network anesthesiologist providing services at an in-network hospital.
- Out-of-network air ambulance items and services.
The bill also prohibits out-of-network providers of ancillary services at an in-network facility from balance billing members. Ancillary services are defined by the No Surprises Act as those related to emergency medicine, anesthesiology, pathology, radiology, neonatology, and laboratory.The original legislation (as introduced) did contain language that APTA opposed that would have also added a mandated disclosure to patients in writing on estimates for prices of services that could have been interpreted as applying to additional providers and settings such as outpatient physical therapy clinics. The version signed into law removed that problematic section of the legislation.