No Surprises Act

Last Updated: December 7, 2022


On December 27, 2020, President Donald Trump signed the Consolidated Appropriations Act, 2021 (CAA) into law. Tucked inside the 1,067-page bill is Section BB, Title I, the No Surprises Act, which establishes new protections for consumers against surprise bills in certain emergency and nonemergency scenarios.

On January 1, 2022, much of the No Surprises Act went into effect. The specifics of the act were laid out in a series of interim final rules jointly released by the US Department of Health & Human Services (HHS), the US Department of Labor and the US Department of the Treasury, along with the US Office of Personnel Management, over the course of 2021.

The first rule, "Requirements Related to Surprise Billing; Part I” was released July 1 and, most importantly, provides a pathway to determining the qualifying payment amount for disputed rates and services. The second rule, “Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement” was released September 10 and mostly concerns air ambulance services but also lays out processes for enforcement against providers and facilities found to be in violation of surprise billing requirements. The third rule, “Requirements Related to Surprise Billing; Part II,” was released September 30 and centers on the independent dispute resolution (IDR) process through which providers and plans will settle out-of-network rate disputes.