The Consolidated Appropriations Act, 2021 (CAA) established protections for consumers related to surprise billing and transparency in health care.
No Surprises Act
Qualifying Payment Amount (QPA)
The QPA is the basis for determining individual cost sharing for items and services covered by Title I (No Surprises Act) of Division BB of the CAA under certain circumstances.
- Qualifying Payment Amount Calculation Methodology (PDF)
- Qualifying Payment Amount Calculation Methodology Presentation
Remittance Advice Remark Codes (RARCs)
RARCs may be used by plans and issuers to communicate information about claims to providers and facilities, subject to state law. The document below contains RARCs that are related to the No Surprises Act.
No Surprises Act FAQs
The document below addresses Frequently Asked Questions (FAQs) regarding implementation of Title I (the No Surprises Act (NSA)) of Division BB of the Consolidated Appropriations Act, 2021 (CAA 2021) and implementing regulations published in the Federal Register on July 13, 2021 and October 7, 2021 as part of interim final rules with comment period, entitled "Requirements Related to surprise Billing: Part I" and "Requirements Related to Surprise Billing: Part II," respectively.
June 23, 2022
- Frequently Asked Questions (FAQs) about Consolidated Appropriations Act, 2021 Implementation - Applicability, Notice and Consent (PDF)
The RxDC is the data collection required under section 204 of Title II (Transparency) of Division BB of the CAA. The law requires insurance companies and employer-based health plans to submit information about prescription drug and health care spending to the Departments of Health & Human Services, Labor, and the Treasury.
2021 State Enforcement Survey
In July 2021, CMS distributed a survey to states intended to capture the state’s authority and intention to enforce specified provisions in Title XXVII of the Public Health Service Act (PHS Act), as amended by Title I (No Surprises Act) and Title II (Transparency) of Division BB of the CAA.
Federal IDR Applicability Chart
These charts provide a high-level summary to assist in determining whether the Federal IDR process or a state law or All-Payer Model Agreement applies for determining out-of-network rates.
- Chart for Determining the Applicability for the Federal Independent Dispute Resolution (IDR) Process (Updated January 13, 2023) (PDF)
- Chart Regarding Applicability of the Federal Independent Dispute Resolution (IDR) Process in Bifurcated States (Updated January 13, 2023) (PDF)
Federal IDR Checklist for Plans and Issuers
This checklist is intended to help plans and issuers understand their obligations and comply with key requirements of the No Surprises Act when processing claims for items and services that fall within the scope of the new surprise billing protections for emergency services, non-emergency services performed by nonparticipating providers at participating health care facilities, and air ambulance services furnished by nonparticipating providers of air ambulance services (“qualified IDR item(s) or service(s)”).
- Federal Independent Dispute Resolution (IDR) Process - Checklist of requirements for group health plans and group and individual health insurance issuers (PDF)
CAA Enforcement Letters
The below letters capture CMS’s understanding of the PHS Act provisions, as extended or added by the CAA, that each state is enforcing either directly or through a collaborative enforcement agreement, and the provisions that CMS is enforcing. These letters also communicate whether the federal independent dispute resolution process and the federal patient-provider dispute resolution process apply in each state, and in what circumstances.