No Surprises Act Enforcement Act
The No Surprises Act Enforcement Act would significantly strengthen enforcement around balance billing protections. It would raise civil penalties on group health plans and health insurance issuers for violations of balance billing requirements and extend similar penalties to nonparticipating providers or facilities. The bill also adds new penalties for late payment or non-payment after an independent dispute resolution (IDR) determination, including a requirement to pay triple the difference between certain payment amounts plus interest. Finally, it expands transparency by imposing enhanced reporting on audits, enforcement actions, penalties, and common violations to Congress and relevant committees, across the Public Health Service Act, the ERISA framework, and the Internal Revenue Code. In short, the bill tightens penalties, strengthens payment enforcement post-IDR determinations, and increases reporting to bolster oversight of balance billing protections.
Key Points
- 1Higher penalties for balance-billing violations by plans/issuers: The bill increases per-violation penalties to as much as $10,000 for specified balance-billing provisions, with the added cross-reference to closely related balance-billing requirements under the No Surprises Act.
- 2Civil penalties against plans/issuers under ERISA and IRC: The act authorizes penalties of up to $10,000 per violation for group health plans or health insurance issuers that fail to comply with listed balance-billing provisions, applying across ERISA and the Internal Revenue Code (IRC), in addition to existing penalties.
- 3Penalties for late payment or non-payment after IDR determinations: For emergency, nonemergency, and air ambulance services, plans and nonparticipating providers/facilities must pay the required amount within a set timeframe after an IDR determination. If payment is late, they must pay triple the difference between the initial payment (or $0 for denied claims) and the out-of-network rate, plus interest. This applies to PHSA, ERISA, and IRC provisions.
- 4Expanded transparency reporting: The bill requires annual and semiannual reporting on audits, enforcement actions, complaints, penalties, corrective actions, and the three most commonly reported violations. This reporting is required under PHSA and IRC, with Congress committees specified for receipt and review.
- 5Scope across major federal authorities: Provisions touch on the Public Health Service Act (PHSA), the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code (IRC) to unify penalties and enforcement related to balance billing and related IDR processes.