No Surprises Act: Implications for BH Providers

October 22, 2022

We wanted to remind all NYS Council members that the NYS Council includes a section on our Annual Dues Calculation Worksheet that allows a member agency to purchase a full membership with the National Council for Mental Wellbeing (formerly the National Council for Behavioral Health) at a fraction of the regular cost (NYS Council price is $625.00) of a membership with the National Council (their price is over $4,700/year).  If you are a member of the NYS Council in good standing and you elected to purchase a membership with us AND with the National Council in Washington D.C., someone on your staff should be receiving information from the National Council in Washington D.C.  If you are not hearing from them, please contact Cindy Levernois, our Director of Member Services and Communications at:
Policy Brief:Recently, the National Council for Mental Wellbeing provided its’ members with some important information regarding the No Surprises Act that was implemented in 2021, and specifically, information regarding a section of the statute related to providing ‘good faith estimates’ to clients with certain types of health insurance.  
Here’s some background information:

  • The No Surprises Act (NSA) was passed as part of the Consolidated Appropriations Act 2021. It imposed new requirements, most of which took effect on January 1, 2022, on both health insurers and various types of providers (including community behavioral health). The goal being to reduce surprise medical bills and make patients’ out-of-pocket costs more transparent/predictable.
  • The requirements pertain to patients who receive emergency services at an out-of-network facility, for emergency or non-emergency care provided by an out-of-network provider at an in-network facility, or individuals who do not use insurance to cover their health care expenses.
  • As of January 1, 2022, patients have billing protections when they receive emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

Here’s National Council analysis re: who this applies to:

  • The regulation uses a very broad definition of “health care facility.” Because of this, the requirement to provide “good faith estimates” would likely apply to any community behavioral health organization.
  • However, the “good faith estimate” requirements only apply to items or services for the uninsured, or individuals who are self-pay. A self-pay individual is a consumer who has insurance coverage, but who does not seek to have a claim for such item or service submitted to the plan.

And here’s a link to the National Council info on the No Surprises Act, and specifically, Section 112:

Additional Resource:“Good Faith Estimate” Templates: