President Biden’s proposed 2024 budget includes substantial additional amounts for continued funding of the implementation and enforcement of the No Surprises Act (NSA) and the transparency laws passed along with the NSA, including prohibitions on gag clauses regarding price and quality information, the required disclosure of indirect compensation for brokers and consultants with respect to employer-sponsored health plans, required reporting on pharmacy benefits and drug costs, and enforcement of the mental health parity comparison requirements.
According to the budget, implementation of the NSA has prevented an estimated one million surprise bills per month.
The budget amounts are in addition to a one-time lump sum appropriation of $500 million that Congress provided in the NSA to the departments of Health and Human Services, Labor, and Treasury (the Departments), which expires in 2024. The budget recognizes that the Departments will have ongoing responsibilities including enforcement of plan, issuer and provider compliance and complaint collection and investigation as well as auditing of comparative analyses of non-quantitative treatment limits for mental health and substance use disorder plan benefits. The budget proposal provides $500 million in additional mandatory funding over a ten-year period for continued implementation of the NSA and the other consumer protection laws passed at the same time as the NSA.
In addition, the budget proposes to extend surprise billing protections to out-of-network ground ambulance services, which were excluded from the NSA, starting in 2025: “As a result, people who take an out-of-network ground ambulance ride during an emergency would only be subject to their in-network cost-sharing amount.” The Office of Management and Budget anticipates that the extension of the NSA to ground ambulance services would save the Treasury $948 million over ten years.
In other updates, as of the date of publication, the Centers for Medicare & Medicaid Services (CMS) has not yet issued any further guidance regarding the Independent Dispute Resolution (IDR) process for services furnished after October 25, 2022. In light of a Texas court’s February 6 ruling vacating portions of the final rule implementing the IDR process for such disputes, CMS notified certified IDR entities that they should hold issuance of payment determinations that involve these items or services until the Departments issue further guidance. To date, no such guidance has been issued.
Manatt Welcomes Nick Bath
We are very happy to welcome coauthor Nick Bath, Partner, Manatt Health, to the Manatt NSA team. Nick recently joined the firm after nearly two decades in health care policy, most recently as health policy director for eight years for the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP), where he was directly involved in developing, drafting, negotiating and enacting groundbreaking health care laws such as the NSA.