No Surprises Act Enforcement Act
Summary
The "No Surprises Act Enforcement Act" aims to strengthen the enforcement of balance billing requirements under the No Surprises Act. It increases penalties for group health plans, health insurance issuers, and nonparticipating providers who violate these requirements. The bill also introduces additional penalties for late or non-payment after an Independent Dispute Resolution (IDR) entity makes a payment determination.
Expected Effects
The act will likely lead to stricter adherence to the No Surprises Act, reducing instances of surprise medical bills. Increased penalties could deter violations and ensure timely payments. The act also mandates more transparent reporting on audits and enforcement actions related to the No Surprises Act.
Potential Benefits
- Reduces surprise medical bills for patients.
- Increases accountability for health plans and providers.
- Ensures timely payments after IDR determinations.
- Provides more transparency through detailed reporting.
- Strengthens consumer protections in healthcare billing.
Potential Disadvantages
- Increased costs for health plans and providers due to penalties, potentially leading to higher premiums.
- Administrative burden for compliance and reporting.
- Potential for disputes over payment determinations and penalties.
- Possible unintended consequences on provider networks and access to care.
- May disproportionately affect smaller healthcare providers.
Constitutional Alignment
The bill aligns with the Constitution's general welfare clause (Preamble) by aiming to improve healthcare access and affordability. Congress has the power to regulate interstate commerce (Article I, Section 8), which includes health insurance and healthcare services. The enforcement mechanisms and penalties are subject to due process considerations under the Fifth Amendment.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).