At Nine Months, No Surprises Act Can Barely Crawl

As with any major new health-care program, the No Surprises Act is off to a challenging start.

The act, which went into effect Jan. 1, is aimed at restricting surprise billings—bills sent to a patient by out-of-network providers that gave the patient with either emergency care or non-emergency services while they were treated in an in-network hospital or ambulatory surgery center.

However, the act’s implementing regulations are incomplete, and regulators have announced delays in enforcing other important provisions of the law, while some enforcement mechanisms are still under construction between the federal and state governments.

The NSA’s short implementation timeline—six months or less between the passage of the act’s implementing rules and its effective date—posed numerous challenges to plans and providers.

Moreover, both have been required to operate under a regulatory regime established by interim final rules promulgated without meaningful feedback from stakeholders or answers from regulators to important questions.

Further complicating matters, professional organizations representing members impacted by the act promptly filed lawsuits aimed at invalidating portions of the interim final rules. The lawsuits claimed the regulations were inconsistent with the law.

As a consequence, health-care providers and facilities continue to struggle with understanding the NSA, operationalizing its requirements, and anticipating what’s coming next.