The Centers for Medicare and Medicaid Services (CMS) has issued answers to frequently asked questions about the No Surprises Act, which was designed to provide billing protection for patients receiving emergency department care or treatment from out-of-network providers employed by in-network facilities. The law went into effect on Jan. 1, 2022.

The Frequently Asked Questions page on the CMS website provides context for provider and facility requirements under the law.

“Generally, the No Surprises protections apply to individuals enrolled in a health care plan, through an employer (whether self-funded or insured, including coverage offered by federal, state, or local governments, or a multiemployer plan), or through the federal Marketplaces, state-based Marketplaces, or directly through an individual market health insurance issuer,” the directive reads. “The rules don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. Each of these programs already has other protections against surprise medical bills. The protections also don’t apply to individuals enrolled in short-term limited duration insurance, excepted benefits (such as stand-alone dental or vision-only coverage), or retiree-only plans. Uninsured and self-pay individuals are also entitled to a good faith estimate, upon request or scheduling of an item or service, through the No Surprises billing protections.”

The directive also clarifies that under the No Surprises Act, providers and practices are required to publicly state their balance billing practices prominently at the location of the facility if the location is publicly accessible, post them on a public website, and provide them in a document distributed to patients in person. It also makes clear in which circumstances patients are allowed to waive surprise billing protections.

“Under the No Surprises Act, if a provider or facility plans to balance bill a patient in circumstances in which that would otherwise be prohibited, the out-of-network provider or an out-of-network emergency facility must provide the patient (or an authorized representative) with a notice detailing the patient’s protections and providing information about the potential costs if the patient waives their surprise billing protections,” the directive states.