This week, U.S. Senators Roger Marshall, MD (R-Kan.), and Michael Bennet (D-Colo.) introduced the No Surprises Act Enforcement Act, a bipartisan effort to ensure that health insurers comply with the payment obligations established under the No Surprises Act. This measure follows a similar bipartisan bill introduced in the House of Representatives in September, signaling strong bicameral support for addressing enforcement gaps under the landmark legislation.
Background on the No Surprises Act
The NSA, effective since January 1, 2022, was designed to protect patients from unexpected medical bills for out-of-network care performed at in-network facilities by prohibiting balance billing for emergency and certain non-emergency services. The NSA also establishes an independent dispute resolution (IDR) process to resolve payment disputes between insurers and providers.
Challenges in Enforcement
Despite the NSA’s protections, enforcement challenges persist. The Centers for Medicare & Medicaid Services (CMS) has received over 16,000 complaints related to the NSA as of mid-2024. Common grievances include payors failing to adhere to the required 30-day period to send the initial payment or denial notice, followed by non-compliance with the 30-day period to make payment after an award determination is issued. These delays place financial burdens on healthcare providers and threaten patient access to care.
Key Provisions of the No Surprises Act Enforcement Act
The new Senate bill aims to close these enforcement gaps through several provisions:
Broad Support from Medical Societies
The legislation has earned strong backing from medical organizations, including the American College of Radiology (ACR), the American College of Emergency Physicians (ACEP), and the American Society of Anesthesiologists (ASA). These groups emphasize the need for effective enforcement to protect providers from financial harm and uphold the patient protections intended by the NSA.
Dr. Alan Matsumoto, Chair of the ACR Board of Chancellors, expressed support, stating, “There is a real need for accountability after disputes are resolved under the No Surprises Act, because right now insurance companies are often just not paying.” (radiologybusiness.com)
Likelihood of Passage
While the bipartisan nature of the bill increases its chances of gaining traction in Congress, its passage may face timing and political hurdles. Despite healthcare enforcement being a key concern across party lines, how the bill fits within the new administration’s broader priorities could delay its approval.
Conclusion
The No Surprises Act Enforcement Act, alongside its House counterpart, represents a critical step toward ensuring the full realization of the NSA’s protections. By holding insurers accountable for timely payments and enhancing transparency, these legislative efforts strive to safeguard both patients and providers.
CHRMS has been dedicated to helping out-of-network providers navigate the often complex and time-sensitive NSA provisions under the Independent Dispute Resolution process, with great success. If you need assistance with NSA related or state surprise bill claims, please contact us – we’re here to help.
