The No Surprises Act was enacted in December 2020 as part of a comprehensive year-end package of spending and COVID legislation. The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) issued a series of interim final rules (IFRs) in 2021 detailing some obligations of providers under the new law as well as patient protections against unexpected out-of-network medical bills. These rules were issued without a prior opportunity for stakeholders to provide comments. APA and many other stakeholder groups were surprised to see the extent to which the rules' provisions covered not only expensive out-of-network services that the new law intended to target, but a broad swath of mental and behavioral health providers as well.
On January 14, APA issued a series of resources to aid members with complying with the new law’s provisions. At the same time, APA spearheaded a January 25 letter to the administration leadership (PDF, 95KB)opens in new window—including HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure—expressing concern about the administrative burdens these rules impose and their likely impact on patient access to services—specifically the requirement that providers issue a “good faith estimate” (GFE) of costs to the patient, even where no significant changes in costs have occurred. The letter also raises concerns that insurers may use these GFEs to reduce coverage of mental and behavioral health services, and that the billing dispute resolution process envisioned under these IFRs opens the door to insurers abusing this process as part of a strategy of further suppressing reimbursement for mental and behavioral health services.
The letter was cosigned by 10 other mental and behavioral health provider associations, including the American Psychiatric Association, the National Association of Social Workers, the American Counseling Association, and the American Association for Marriage and Family Therapy.
The association will seek to engage in further discussions with the administration on this issue and will continue to monitor further rulemaking under the No Surprises Act as it continues to unfold.
For more information, contact Andrew Strickland, JD.