Consolidated Appropriations Act, 2021 (CAA)

Consolidated Appropriations Act, 2021 (CAA)

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.

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


Prescription Drug and Health Care Spending Data Collection (RxDC)

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.

Gag Clause Prohibition Compliance Attestation

A Gag Clause Prohibition Compliance Attestation (GCPCA) is required under section 201 of Title II (Transparency) of Division BB of the CAA.  The law requires certain plans and issuers to submit an attestation of compliance to the Departments of Health & Human Services, Labor, and the Treasury on an annual basis.

Air Ambulance Data Collection (AADC)

The AADC is the data collection required under section 106 of the No Surprises Act. The law requires air ambulance providers, insurance companies, and employer-based health plans to submit information about air ambulance services provided to consumers.


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

This chart provides 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.

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)”).

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.

Alabama (As of December 8, 2021) (PDF)

Alaska (As of February 15, 2022) (PDF) 

American Samoa (As of December 8, 2021) (PDF)

Arizona (As of February 23, 2022) (PDF)

Arkansas (As of December 21, 2021) (PDF)

California (As of December 22, 2021) (PDF)

Colorado (As of January 18, 2022) (PDF)

Connecticut (As of December 8, 2021) (PDF)

Delaware (As of January 31, 2022) (PDF)

District of Columbia (As of December 8, 2021) (PDF)

Florida (As of January 28, 2022) (PDF)

Georgia (As of December 13, 2021)  (PDF)

Guam (As of December 23, 2021) (PDF)

Hawaii (As of May 20, 2022) (PDF)

Idaho (As of December 9, 2021) (PDF)

Illinois (As of April 27, 2022) (PDF)

Indiana (As of December 15, 2021) (PDF)

Iowa (As of December 9, 2021) (PDF)

Kansas (As of December 13, 2021) (PDF)

Kentucky (As of December 21, 2021) (PDF)

Louisiana (As of December 20, 2021) (PDF)

Maine (As of December 22, 2021) (PDF)

Maryland (As of May 18, 2022) (PDF)

Massachusetts (As of December 22, 2021) (PDF)

Michigan (As of July 20, 2023) (PDF)

Minnesota (As of December 23, 2021) (PDF)

Mississippi (As of December 27, 2021) (PDF)

Missouri (As of December 23, 2021) (PDF)

Montana (As of December 27, 2021) (PDF)

Nebraska (As of December 27, 2021) (PDF)

Nevada (As of February 24, 2022) (PDF)

New Hampshire (As of December 22, 2021) (PDF)

New Jersey (As of February 4, 2022) (PDF)

New Mexico (As of December 22, 2021) (PDF)

North Carolina (As of December 27, 2021) (PDF)

North Dakota (As of December 15, 2021) (PDF)

Northern Mariana Islands (As of December 28, 2021) (PDF)

Ohio (As of February 17, 2022) (PDF)

Oklahoma (As of December 9, 2021) (PDF)

Oregon (As of December 21, 2021) (PDF)

Pennsylvania (As of February 7, 2022) (PDF)

Puerto Rico (As of December 8, 2021)  (PDF)

Rhode Island (As of December 22, 2021) (PDF)

South Carolina (As of December 28, 2021) (PDF)

South Dakota (As of December 15, 2021) (PDF) 

Tennessee (As of January 26, 2024) (PDF)

Texas (As of January 25, 2022) (PDF)

U.S. Virgin Islands (As of December 9, 2021) (PDF) 

Utah (As of December 20, 2021) (PDF)

Vermont (As of December 22, 2021) (PDF)

Virginia (As of December 21, 2021) (PDF)

Washington (As of December 21, 2021) (PDF)

West Virginia (As of December 13, 2021) (PDF) 

Wisconsin (As of December 10, 2021) (PDF) 

Wyoming (As of December 9, 2021) (PDF)

Page Last Modified:
01/26/2024 03:39 PM