The No Surprises Act “NSA” went into effect January 1, 2022, and protects most consumers enrolled in individual and group health insurance plans from surprise medical bills in certain circumstances.  Enforcement of the NSA generally involves both state and federal governments. The NSA originally allows the states to enforce the provisions of the NSA unless the state is unable to do so. In that scenario, the federal government will enforce the provisions of the NSA in that state.

Based on survey responses and CMS communications between the Centers for Medicare & Medicaid Services and the Louisiana Department of Insurance, “CMS understands that Louisiana lacks authority to enforce the [NSA] provisions.” Therefore, CMS “will assume direct enforcement of these new protections.” Louisiana is one of a handful of states that has deferred enforcement of all provisions of the NSA to the federal government.

We will continue to monitor enforcement of the NSA on a federal level as it relates to enforcement in Louisiana.

Written by Catherine B. Moore.

As mentioned in a previous article Recent CMS Guidance Could Jeopardize Medicare Provider Agreement, the Centers for Medicare & Medicaid Services (“CMS”) recently issued Survey and Certification Memo: 17-44-Hospitals (“S&C 17-44”) which requires hospitals to have a minimum of two inpatients at the time of survey, as well as an average length of stay (“ALOS”) and average daily census (“ADC”) of two over the past twelve months. At the time of that article (February 2018), CMS had not yet issued any public notices of intent to terminate a hospital’s Medicare Provider Agreement for failing to be “primarily engaged” in providing services to inpatients.  That has since changed. Continue reading →