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State Law vs. The No Surprises Act

In addition to the federal No Surprises Act, many states have their own laws that protect consumers from surprise medical bills. In the states with their own laws, Claritev examines which law takes precedence.

January 17, 2022 |
woman reading legal documents at a table with gavel and legal scales

In addition to the federal No Surprises Act, many states have their own laws that protect consumers from surprise medical bills. In the states with their own laws, providers and payors may be confused on which law takes precedence.

 

What takes precedence, state or federal surprise bill protections?
The No Surprises Act explicitly defers to certain state laws for the out-of-network services that are covered under both the state law and the Act. State laws take precedence when the state law applies to:

 

  • The plan, issuer, or coverage involved (i.e., it’s an insured plan)
  • The provider (i.e., the provider is licensed in the state where the plan is underwritten) and
  • The services (i.e., the state law covers the services at issue)

The regulation states, “In instances where a state law does not satisfy all of these criteria, the state law does not apply.”  Here are some examples: 

Issuer Licensed Facility/Provider Licensed State Law Covers Services Provided Jurisdiction
State A State A Yes State Law
State A State B Yes NSA (Federal Law)
State A State A No NSA (Federal Law)
ERISA Opt in to State A State A Yes State Law

Air ambulance services are treated differently, because the federal Airline Deregulation Act prohibits states from setting payment rates for air ambulances. Air ambulances are, therefore, always subject to the No Surprises Act.

 

What about ERISA plans?
Generally speaking, ERISA plans are subject to federal, not state law.  However, if the state has a surprise billing law that allows for ERISA plans to “opt-in,” an ERISA plan that has opted in is subject to the state law for purposes of surprise bill handling, subject to the above conditions. 

Learn how Claritev’s Surprise Billing Service can help you comply with requirements of the No Surprises Act.

 

The information provided on this website does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this site are for general informational purposes. If you have questions about how the No Surprises Act applies to your organization, please consult your legal counsel.

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