S. 2420 — No Surprises Act Enforcement Act

This section increases civil penalties to $10,000 per violation per individual (from $100) for group health plans and health insurance issuers that fail to comply with specified balance billing protections (i.e., prohibitions on surprise billing for emergency and non-emergency out-of-network services at in-network facilities, and related air ambulance provisions, as enacted in the No Surprises Act). It does so by (1) amending the Public Health Service Act to apply the higher penalty amount to specified provisions; (2) amending ERISA section 502 to add subsection (c)(12) authorizing the higher penalty and updating cross-references in subsections (a)(6) and (b)(3); and (3) amending the Internal Revenue Code to apply the higher penalty amount to specified provisions.

This section amends the payment timing requirements following an independent dispute resolution (IDR) determination under the No Surprises Act's protections against surprise medical bills (i.e., for emergency services, nonemergency services furnished by out-of-network providers at in-network facilities, and air ambulance services). For ERISA group health plans (29 U.S.C. 1185e(c)(6)), and parallel provisions governing health insurance issuers under the Public Health Service Act (42 U.S.C. 300gg–111, 300gg–112), it (1) requires the owing party (plan/issuer or nonparticipating provider/facility) to notify the Secretary of the payment upon making it; (2) requires nonparticipating providers/facilities to refund plans/issuers any excess (if the IDR amount is less than the initial payment plus cost-sharing) within 30 days of the determination; and (3) imposes a penalty on late or non-payers equal to three times the difference between the initial payment (or $0 if denied) and the out-of-network rate less cost-sharing, plus interest as specified by the Secretary.

This section revises audit and enforcement reporting requirements for No Surprises Act protections (i.e., prohibitions on surprise balance billing for emergency services, air ambulance services, and certain non-emergency out-of-network services at in-network facilities) under the Public Health Service Act (PHSA §2799A–1, applicable to health insurance coverage) and Internal Revenue Code (IRC §9816, applicable to self-insured group health plans). Under the revisions— (1) initial reporting, from 2022 through December 31 of the calendar year of enactment, requires the relevant Secretary to submit an annual report to Congress on the number of plans and issuers (PHSA) or plans (IRC) audited; (2) subsequent reporting, beginning not later than February 1 of the first calendar year after enactment and every six months thereafter, requires the Secretaries of HHS, Labor, and Treasury (as applicable) to submit coordinated reports to the House Committees on Ways and Means, Energy and Commerce, and Education and the Workforce and the Senate Committees on Finance and Health, Education, Labor, and Pensions covering the prior six-month period, including (A) total audits and audits of specified types, (B) complaints by providers, participants, beneficiaries, or enrollees, (C) enforcement actions, (D) civil monetary penalties (total number and aggregate dollar amount), (E) non-monetary corrective actions, and (F) the three most commonly reported violations.