No Surprises Act Enforcement Act
- Bill Number
- S. 2420
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-23: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- Last Updated
- 2025-12-05T22:48:36Z
AI-Generated Summary
Summary of S. 2420: No Surprises Act Enforcement Act
Purpose
This legislation aims to strengthen enforcement of existing rules that prevent surprise medical billing by increasing financial penalties for violations by health plans, insurers, and certain providers or facilities. It also introduces new penalties for delays in payments following dispute resolution and requires more detailed public reporting on enforcement activities.
Key Provisions
- Increased Penalties for Violations: Amends the Public Health Service Act (PHSA), Employee Retirement Income Security Act of 1974 (ERISA), and Internal Revenue Code (IRC) to raise civil penalties from $100 to $10,000 per violation for specific balance billing rules, such as requirements to limit patient costs for emergency and certain non-emergency services.
- Penalties for Late or Non-Payment After Dispute Resolution: Adds rules requiring payment within 30 days of an independent dispute resolution (IDR) determination. Failure to pay triggers an additional penalty equal to three times the difference between the initial payment and the final rate, plus interest. Parties must also notify the relevant Secretary of payments made.
- Enhanced Reporting Requirements: Updates audit and enforcement reporting under the PHSA and IRC to include more frequent (every six months) submissions to Congress. Reports must detail the number of audits, complaints received, enforcement actions, total penalties issued, corrective actions taken, and the most common violations.
Significant Changes to Existing Law
- Raises the per-violation penalty amount significantly for group health plans, health insurance issuers, and nonparticipating providers or facilities that violate balance billing protections.
- Introduces a new mandatory 30-day payment timeline and a triple-damages penalty (plus interest) for late or missing payments after IDR decisions.
- Expands transparency obligations by shifting from annual to biannual reporting and requiring specific data on complaints, penalties, and violation trends.
Potential Impacts
- On Government Agencies: Increases workload for the Departments of Health and Human Services, Labor, and the Treasury, which must conduct more audits, process notifications, issue penalties, and prepare detailed congressional reports.
- On Citizens: May improve compliance with patient protections against unexpected medical bills, potentially reducing out-of-pocket costs, though it could indirectly affect insurance premiums if plans face higher compliance expenses.
- On International Relations: No direct effects identified in the legislation.
Main Stakeholders Affected
- Group health plans and health insurance issuers, which face higher fines and new payment obligations.
- Nonparticipating providers and facilities, which may incur penalties for late payments or violations.
- Patients, beneficiaries, and enrollees, who benefit from stronger enforcement of billing protections.
- Federal agencies responsible for oversight and reporting.
- Congressional committees that receive the new periodic reports.
Notable Legal, Constitutional, or Political Implications
- The bill operates within existing federal authority over health insurance regulation through amendments to established statutes, with no apparent constitutional conflicts noted.
- It enhances administrative enforcement mechanisms without creating new regulatory bodies.
- The emphasis on frequent reporting and higher penalties could lead to increased litigation or disputes over penalty assessments and payment calculations.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Sen. Bennet, Michael F. [D-CO]
Recent Actions
- 2025-07-23: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2025-07-23: Introduced in Senate
Bill Versions
- No Surprises Act Enforcement Act — issued 2025-07-23 — PDF (27 pages)