HR4710-119

What This Bill Does

The No Surprises Act Enforcement Act targets enforcement gaps in surprise-billing protections. It amends the Public Health Service Act, ERISA, and the Internal Revenue Code so group health plans and health insurance issuers can face civil penalties of up to $10,000 per affected individual for failures involving specified No Surprises Act provisions, including emergency-service protections, nonparticipating-provider and facility protections, air ambulance protections, and cost-sharing or payment rules. It also amends independent dispute resolution payment rules. When a plan, coverage, nonparticipating provider, or nonparticipating facility owes money under an IDR determination, the party must notify HHS when payment is made. If required payment is late or missing, the nonpaying party must make the payment and also pay an amount equal to three times the difference between the initial payment or denial and the out-of-network rate, plus interest specified by the Secretary. The bill adds parallel provisions across the health-code, ERISA, and tax-code versions of the No Surprises Act. For transparency, the Secretary, coordinated with Labor and Treasury, must move from annual audit reports to semiannual reports to House and Senate health, tax, labor, and finance committees. Those reports must disclose total audits, audits tied to specified provisions, provider and patient complaints, enforcement actions resulting from complaints, civil monetary penalties and aggregate dollar amounts, non-monetary corrective actions against plans or issuers, and the three most commonly reported violations.

Who Benefits and How

Patients protected by the No Surprises Act benefit from stronger penalties when plans or issuers violate balance-billing and cost-sharing protections. Out-of-network providers benefit when plans or issuers miss IDR payment deadlines because the bill adds triple-difference penalties and interest. Health plans benefit when nonparticipating providers or facilities owe refunds after an IDR decision because the same late-payment penalty works both ways. Congressional health committees benefit from semiannual enforcement reports with audits, complaints, penalties, corrective actions, and common violations.

Who Bears the Burden and How

Group health plans and health insurance issuers face higher per-person penalties for specified No Surprises Act failures. Nonparticipating providers and facilities must make required IDR payments or refunds on time and report payment notifications. HHS Secretary, Labor Secretary, and Treasury Secretary must coordinate semiannual audit and enforcement reporting. Federal regulators must track complaints, civil penalties, corrective actions, and common violation patterns across three statutory regimes.

Key Provisions

• Increases specified balance-billing violation penalties to as much as $10,000 per affected individual.
• Requires payment notifications after independent dispute resolution determinations.
• Creates triple-difference plus interest penalties for late or missed IDR payments.
• Requires semiannual reports on audits, complaints, enforcement actions, penalties, corrective actions, and common violations.
• Amends the Public Health Service Act, ERISA, and Internal Revenue Code versions of the No Surprises Act.