Compliance Corner

Federal Updates

CMS Requires Agency Contact Information for Certain No Surprise Billing Disclosures

November 09, 2021

On October 25, 2021, CMS issued a memorandum to group health plans and insurers (among others) regarding agency contact information that must be included on certain No Surprises Act (the Act) notices and disclosures. 

The Act is part of the Consolidated Appropriations Act, 2021 (CAA) passed by Congress in late 2020. Among its requirements, group health plans and insurers must post a notice disclosing the prohibition on surprise billing effective for plan years beginning in 2022. The notice must be made publicly available, posted on a public website of the plan or issuer, and included in each explanation of benefits. It is one page and must provide information concerning requirements and prohibitions under the Act, any applicable state balance billing limitations or prohibitions, and contact information for appropriate state and federal agencies if someone believes the provider or facility has violated the requirements described in the notice. A model notice was made available in the initial regulations. (For more information on the Act and the interim final rules, see the article published in the July 7, 2021, edition of Compliance Corner.)

The text of the model notice includes fields that must be completed by entering the URL for a website describing the federal balance billing protections and contact information for the applicable federal and state agencies. In the memorandum, CMS identifies the website to be included in the model notice where federal agency contact information is required. The website provides general information about the Act’s provisions, with additional information to be posted over the next several months. While the website is not fully complete or functional, it will be operational in January 2022 to receive complaints and other inquiries. HHS also operates a telephone number as another mechanism to submit complaints regarding potential violations of the CAA, which will then be routed to the appropriate agency as needed. Importantly, CMS requests that the phone number (1.800.985.3059) not be included in any plan documents for plan or policy years beginning before January 1, 2022.  

While agencies indicated that additional guidance might be forthcoming regarding surprise billing disclosure requirements, plans should make good faith efforts to comply using the model notice and agency contact information provided by this memorandum for plan years beginning on or after January 1, 2022.

CMS Memo »
Model Notice »
CMS Website »