Law360

The No Surprises Act, or NSA, which goes into effect Jan. 1, 2022, introduces new requirements at the federal level that aim to protect consumers from unexpected and expensive medical bills.

Authors: Alexandra M. Lucas Christian Martin

For out-of-network emergency services and services received from nonparticipating providers at in-network facilities, the NSA caps patients' financial responsibility and creates a dispute resolution process for providers and payors to settle payment disputes.

State balance billing laws will play a major part in how stakeholders operationalize the NSA's requirements. This is because Congress drafted the NSA so that it would not apply where a state has itself legislated a remedy to surprise billing.

Specifically, if a state law applies to the patient's health care services and constitutes a specified state law, then it completely supplants the NSA's provisions regarding patient cost-share calculations, provider payments and dispute resolution.