No Surprises Act Enforcement Act
- Bill Number
- H.R. 4710
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-19T08:06:59Z
AI-Generated Summary
Purpose of the Legislation
The "No Surprises Act Enforcement Act" (H.R. 4710) aims to strengthen enforcement of protections against surprise medical billing, which occurs when patients receive unexpected out-of-network charges for emergency care, nonemergency services at in-network facilities, or air ambulance services. It increases financial penalties for violations by group health plans (employer-sponsored insurance) and health insurance issuers (companies selling plans), ensures timely payments after dispute resolutions, and improves government reporting on compliance.
Key Provisions
- Increased Penalties for Violations:
- Raises civil monetary penalties from $100 per day to $10,000 per failure for specific breaches of balance billing rules. These rules protect patients from balance bills (extra charges beyond what insurance covers) in scenarios like emergency room visits, care at in-network hospitals by out-of-network providers, and air ambulance transports.
- Applies to targeted sections of existing laws covering patient protections, such as requirements for plans to pay out-of-network providers at fair rates and notify patients of costs.
- Penalties for Late or Non-Payment After Dispute Resolution:
- After an independent dispute resolution (IDR) process determines payment amounts between plans/issuers and out-of-network providers, both parties must settle within 30 days (e.g., if the IDR favors the provider, the plan pays; if it favors the plan, the provider refunds).
- Failure to pay on time triggers a penalty of three times the difference between the initial payment (or $0 if denied) and the out-of-network rate (minus patient cost-sharing, like deductibles). Interest is added to the penalty amount.
- Parties must notify the relevant government secretary (e.g., Health and Human Services) of payments made.
- Enhanced Transparency and Reporting:
- Requires federal agencies (Departments of Health and Human Services, Labor, and Treasury) to submit semi-annual reports to Congress starting the year after enactment. These cover audits, complaints from providers or patients, enforcement actions, total penalties issued, non-monetary corrections (e.g., policy changes by plans), and the three most common violations.
- Until enactment of a related bill (Enhanced Enforcement of Health Coverage Act), reporting remains annual and simpler, focusing on audit numbers.
The changes amend three key laws: the Public Health Service Act (for individual and group markets), Employee Retirement Income Security Act (ERISA, for employer plans), and Internal Revenue Code (for tax-related enforcement).
Significant Changes to Existing Law
- Penalty Escalation: Under the original No Surprises Act (part of the 2021 Consolidated Appropriations Act), penalties were relatively low ($100 per day). This bill makes them flat $10,000 per violation for core protections, acting as a stronger deterrent without daily accrual.
- New Payment Enforcement: Introduces specific timelines and triple-damages penalties for post-IDR delays, which were not previously detailed. This closes gaps where plans or providers could delay refunds or payments without severe consequences.
- Reporting Frequency and Detail: Shifts from annual to semi-annual reports with more granular data (e.g., complaint sources, penalty totals), improving oversight. References a future "Enhanced Enforcement of Health Coverage Act" for triggering fuller reporting.
Potential Impacts
- On Government Agencies: Increases workload for the Departments of Health and Human Services, Labor, and Treasury in conducting audits, processing notifications, enforcing penalties, and preparing detailed reports. This could lead to better monitoring but strain resources without additional funding.
- On Citizens (Patients): Enhances protections against surprise bills, potentially reducing unexpected medical debt for the roughly 10-20% of emergency visits involving out-of-network care. Patients benefit indirectly through faster resolutions and fewer billing disputes.
- On Health Plans, Issuers, and Providers: Plans and issuers face higher financial risks for non-compliance, encouraging stricter adherence to billing rules. Out-of-network providers (e.g., specialists, ambulance services) gain assured timely payments, but must also comply or face penalties. Overall, it may reduce disputes but increase operational costs for tracking and reporting.
- On International Relations: No direct impact, as this focuses on domestic U.S. health insurance regulations.
Main Stakeholders Affected
- Group Health Plans and Health Insurance Issuers: Primary targets for penalties; must update compliance processes to avoid fines.
- Nonparticipating (Out-of-Network) Providers and Facilities: Doctors, hospitals, and air ambulance operators benefit from enforced payments but are also liable for delays in refunds.
- Patients (Participants, Beneficiaries, Enrollees): Everyday insured individuals, especially those using emergency or ambulance services, who are shielded from balance bills.
- Federal Agencies: Departments of Health and Human Services (HHS), Labor (DOL), and Treasury enforce rules, conduct audits, and report to Congress.
- Congress: Receives detailed reports to oversee implementation and address ongoing issues in healthcare billing.
Notable Legal, Constitutional, or Political Implications
- Legal: Bolsters the No Surprises Act's framework by making enforcement more robust and punitive, potentially reducing court challenges over billing disputes through faster IDR resolutions. The triple-damages penalty introduces a liquidated damages approach (pre-set compensation for breaches), which courts may scrutinize for fairness but aligns with consumer protection laws like those for debt collection.
- Constitutional: No major concerns; Congress has broad authority under the Commerce Clause to regulate health insurance markets affecting interstate commerce. Amendments to ERISA and tax code are standard for federal oversight of benefits and deductions.
- Political: Sponsored by a bipartisan group (Democrats and Republicans), reflecting consensus on curbing surprise billing—a popular issue post-2021 implementation challenges. It could influence broader healthcare debates by emphasizing enforcement over new entitlements, but may draw opposition from insurers over costs. The bill's referral to multiple committees (Energy and Commerce, Education and Workforce, Ways and Means) signals potential for amendments during review.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Murphy, Gregory F. [R-NC-3]
Cosponsors (36)
Rep. Panetta, Jimmy [D-CA-19], Rep. Joyce, John [R-PA-13], Rep. Schrier, Kim [D-WA-8], Rep. Onder, Robert F. [R-MO-3], Rep. Ruiz, Raul [D-CA-25], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Van Duyne, Beth [R-TX-24], Rep. Harris, Andy [R-MD-1], Rep. Morelle, Joseph D. [D-NY-25], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Conaway, Herbert C. [D-NJ-3], Rep. Moran, Nathaniel [R-TX-1], Rep. Lawler, Michael [R-NY-17], Rep. Dunn, Neal P. [R-FL-2], Rep. Pappas, Chris [D-NH-1], Rep. Friedman, Laura [D-CA-30], Rep. Moore, Blake D. [R-UT-1], Rep. Malliotakis, Nicole [R-NY-11], Rep. Van Drew, Jefferson [R-NJ-2], Rep. DelBene, Suzan K. [D-WA-1], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Bilirakis, Gus M. [R-FL-12], Rep. Kennedy, Mike [R-UT-3], Rep. LaLota, Nick [R-NY-1], Rep. Johnson, Julie [D-TX-32], Rep. Soto, Darren [D-FL-9], Rep. Mace, Nancy [R-SC-1], Rep. Wilson, Joe [R-SC-2], Rep. McGuire, John J. [R-VA-5], Rep. Scholten, Hillary J. [D-MI-3], Rep. Beatty, Joyce [D-OH-3], Rep. Rutherford, John H. [R-FL-5], Rep. Thanedar, Shri [D-MI-13], Rep. Gottheimer, Josh [D-NJ-5], Rep. Miller, Carol D. [R-WV-1], Rep. Alford, Mark [R-MO-4]
Recent Actions
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-23: Introduced in House
- 2025-07-23: Introduced in House
Bill Versions
- No Surprises Act Enforcement Act — issued 2025-07-23 — PDF (27 pages)