No Surprises Act Enforcement Act

This bill increases penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities that violate balance billing requirements under the No Surprises Act, and adds new penalties for late or non-payment after an independent dispute resolution (IDR) entity's payment determination, along with new transparency reporting requirements.

Sec. 2, Increasing penalties for group health plans and health insurance issuers for practices that violate balance billing requirements: This section raises the civil penalty for certain violations of balance billing rules from $100 to $10,000 per violation under the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986. The specific provisions subject to the higher penalty are listed in each law.

Sec. 3, Additional penalties for late payment or non-payment after IDR entity payment determination: This section adds a penalty for plans, issuers, or nonparticipating providers or facilities that fail to make a required payment within 30 days after an IDR determination. The penalty is three times the difference between the initial payment (or $0 if denied) and the out-of-network rate, plus interest. It also requires notification to the Secretary when a payment is made. These rules apply to emergency and nonemergency services and air ambulance services under all three laws.

Sec. 4, Transparency reporting requirements: This section changes the reporting frequency for audits and enforcement actions related to balance billing violations. Instead of an annual report to Congress, the Secretary must submit a report every six months to specified congressional committees, starting the first calendar year after enactment. The report must include the number of audits, complaints, enforcement actions, civil monetary penalties, non-monetary corrective actions, and the three most commonly reported violations.