Enforcement letters have been released by the Centers for Medicare & Medicaid Services (CMS) for a majority of states regarding the execution of certain provisions of the Consolidated Appropriations Act of 2021 (CAA). The CAA, enacted on Dec. 27, 2020, established new protections for consumers related to transparency in healthcare and surprise billing (under the No Surprises Act).
The letters address:
- CMS’s understanding of the provisions each state is enforcing, either directly or through a collaborative enforcement agreement;
- The provisions that CMS will directly enforce;
- Whether the federal independent dispute resolution process and the federal patient-provider dispute resolution process apply in each state, and in what circumstances.
According to CMS, under a collaborative enforcement agreement, the state will perform the compliance functions of policy form review, investigations, market conduct examinations and consumer assistance, as applicable. CMS will consider taking formal enforcement action, to the extent warranted, only where the state is unable to obtain voluntary compliance.
STATES WITHOUT CMS LETTERS
Currently, there are seven states without enforcement letters:
- Alaska
- Arizona
- Illinois
- Nevada
- New York
- Ohio
- Tennessee
ADDITIONAL RESOURCES
CMS has also created a No Surprises Act webpage, which provides fact sheets on what the rules cover, consumer information about the rights and protections available, and information on how to resolve out-of-network payment disputes.
Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.
