CFA UPDATE: Consolidated Appropriations Act (CAA)

No Surprises Act

Ensuring cost transparency and payment integrity in healthcare

In December 2020, Congress signed the Consolidated Appropriations Act (CAA) into law. One section of the new law, referred to as the No Surprises Act, contains new requirements for cost transparency and provides protections for consumers against surprise medical billing.

What changes are CareFirst Administrators making in response to the No Surprises Act?

CareFirst Administrators is updating and re-releasing ID cards upon renewal, which will include new benefit information (for plan years beginning January 2022 or later):

• Office visit copay
• Specialist copay
• Emergency copay
• Medical deductible individual/family
• Rx deductible (if applicable)
• Max out-of-pocket individual/family

CareFirst Administrators will make in-network provider negotiated rates and historical out-of-network allowed amounts available online through machine-readable files posted on our website and updated monthly. Based on current legislation requirements, the in-network and out-of-network files have been available to the public as of July 2022.

Surprise Billing: CareFirst Administrators will administer the no surprise billing regulation. Patients will only be responsible for in-network cost-sharing amounts in emergencies and non-emergency situations where patients cannot choose an in-network provider. For these services and circumstances, out-of-network providers may not balance bill patients (or hold patients liable) for any amounts exceeding in-network charges.

CareFirst Administrators is continuing to review and implement mandates in response to the No Surprises Act. The following are being vetted and will be updated based on upcoming regulation requirements:

• Cost transparency
• Advanced explanation of benefits