Sponsors (2)
The bill strengthens enforcement and transparency to protect insured patients from surprise billing but does so by imposing substantial penalties and new administrative obligations that could raise costs for plans, employers, and providers and risk uneven implementation.
Insured patients (especially those with chronic conditions) will face fewer surprise out-of-network bills and better protection from improper charges due to stronger enforcement, required notifications, and new payment rules.
Providers and plans get clearer, harmonized rules across HHS, Labor, and Treasury, reducing legal uncertainty about which provisions apply.
New financial deterrents (civil penalties up to specified amounts and large late-payment damages) create strong incentives to comply, likely reducing violations and improper billing.
Group health plans and employers face significant new financial liability from penalties and damages, which could raise premiums, lead some plans to narrow benefits, or push costs onto employees and taxpayers.
Large late-payment damages (e.g., triple damages plus interest) risk causing cash-flow strain for providers—including hospitals and air ambulances—if deadlines are missed, potentially threatening services or access in some areas.
The prospect of hefty penalties may incentivize plans to adopt aggressive initial denials or delay payments to avoid later liability, which could delay care or increase disputes for patients.
Based on analysis of 4 sections of legislative text.
Introduced July 23, 2025 by Roger Wayne Marshall · Last progress July 23, 2025
Expands federal enforcement of the No Surprises Act across the Public Health Service Act, ERISA, and the Internal Revenue Code by specifying additional balance-billing provisions subject to enforcement and by authorizing civil monetary penalties (up to $10,000 per person per violation). Requires plans/issuers and nonparticipating providers/facilities to make required payments after an independent dispute resolution (IDR) decision within 30 days, notify the Secretary when payments are made, and imposes a late-payment penalty equal to three times the unpaid difference plus interest. Also requires annual reporting (beginning with 2022 through the enactment year) to Congress on audits of plans/issuers.