For a “No Surprises Act” State law to apply, the law must, among other things, prohibit balance billing of the patient and provide for a methodology to resolve payment disputes between the payor and provider. Further, the State law must apply to the member’s plan and the services being provided.
Full Answer
What is the “No Surprises Act”?
The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
Do states have their own laws on surprise billing?
States with their own surprise billing protections will need to evaluate whether their state laws conflict with, or provide equal or greater consumer protections than the federal law on these specific provisions, as applicable.
What does the “No Surprises Act” mean for APCDs?
The Advisory Board on APCDs must also include a state APCD representative. The “No Surprises Act” extends protections to millions of consumers across the country and states have the opportunity to build on these protections to promote financial stability and reduce health care costs.
What is the No Surprises Act?
The “No Surprises Act” extends protections to millions of consumers across the country and states have the opportunity to build on these protections to promote financial stability and reduce health care costs. For more information on the “No Surprises Act” and other measures included in the COVID-19 relief package and government funding bill, ...
How many states have balance billing laws?
More than half of all states have enacted their own balance billing laws, including 17 states that have comprehensive protections in law. In general, the federal law applies the same framework for interaction with state law as applies under HIPAA and the ACA.
Who is on the Advisory Board on Ground Ambulances and Patient Billing?
An Advisory Committee on Ground Ambulances and Patient Billing, which will make recommendations for state policymakers within their authority and for Congress, will include a state insurance regulator representative. The Advisory Board on APCDs must also include a state APCD representative.
Who is responsible for enforcing the Affordable Care Act?
As with the Affordable Care Act and other major laws under the Public Health Service Act, states are the primary enforcers of the provisions that apply to insurers and fully insured group health plans, with the federal government enforcing in states that fail to substantially enforce the law.
Does Maryland have an all payer model agreement?
The federal law also defers to states that have an “ All Payer Model Agreement,” such as exists in Maryland, to determine the amount to be paid by an insurer to an out-of-network provider or facility. However, the federal arbitration regime would apply to self-funded plans regulated through the Department of Labor.