The following are Frequently Asked Questions (FAQs) regarding the implementation of various components of the No Surprises Act (NSA) of Division BB of the Consolidated Appropriations Act, 2021 (CAA 2021). The FAQs also cover implementing regulations published in the Federal Register on July 13, 2021, as part of interim final rules with comment period, entitled “Requirements Related to Surprise Billing; Part I” and on October 7, 2021, as part of interim final rules with comment period, entitled “Requirements Related to Surprise Billing; Part II.”
The Department of Health and Human Services (HHS) prepared the FAQs to address the provision of the Federal Independent Dispute Resolution system and Notice of Consent requirements. The substance contained in the answers does not have the force and effect of law and is not meant to bind the public in any way unless expressly incorporated into a contract. The only purpose of the FAQ document is to provide clarity to the public about existing requirements under the law.
The information provided serves only as a general, informal summary of technical legal standards. It does not replace the underlying statutes, regulations, or formal policy guidance upon which it is based. Instead, this document summarizes current policy and operations as of the date presented. Taxpayers should reference the applicable statutes, regulations, and other interpretive materials for complete and current information.
Q. Will the Model Standard Notice and Consent Document notice be changing?
A. The Model Standard Notice and Consent Document is the standard form available for use by out-of-network providers and facilities to satisfy the notice and consent exception to balance billing. Health care providers and facilities are under no legal requirement to use the model notice to meet these disclosure requirements.
CMS published revised model notices and a Federal Register notice on November 19, 2021, providing the public a 60-day comment period. The revised model notices will replace the currently approved emergency model notices, which will expire on March 31, 2022.
Q. Is a walk-through of the Federal Independent Dispute Resolution (IDR) system available? If so, when?
A. Technical training on how to use the IDR system is forthcoming in 2022.
Q. What happens if a patient decides to get elective, non-emergency care from an out-of-network provider at an in-network facility? Is that out-of-network provider required to present a Model Standard Notice and Consent Document if the provider wants to be able to bill the patient for any charges not covered by the patient’s insurance?
A. If the provider is out-of-network and the facility in which the non-emergency care would be provided is in-network, and the services are not of the type that the regulations prohibit a provider from seeking consent for (for example, ancillary services, etc.), then notice must be provided and consent obtained for the provider to balance bill. If the patient declines to give consent, the provider is not required to provide the services. If the provider chooses to furnish the care anyway, the provider is not permitted to balance bill the patient.
Q. Can you provide any information on how the various payers will be returning in-network and out-of-network indicators for the requesting providers in advance of the No Surprises Act?
A. The rules do not establish specific requirements regarding the indicators that any plans and issuers must use in responding to providers.
Q: Which physician types do the No Surprises Act rules apply to?
A. Any physician or other healthcare provider acting within the scope of practice of that provider’s license or certification under applicable State law may be subject to the rules, depending upon the rule. For example, a provider who never furnishes services in connection with a visit to a health care facility or emergency facility would generally not furnish items or services that fall within the balance billing protections. But, that same provider may need to provide a good faith estimate of expected charges to uninsured or self-pay individuals.
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