The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

Unexpected medical bills are a significant source of stress, frustration, and confusion for people in the United States. The No Surprises Act gives them new rights to prevent, navigate, and find resolutions to many of these “surprise” bills.

To help consumers understand their rights, consumer-friendly web pages are now available for people with easy-to-read information and actionable guidance. The webpages’ design and content were informed by human-centered design research and user testing with patients, caregivers, patient advocates, and others.

The webpage aims to be inclusive and accessible by:

• Meeting Web Content Accessibility Guidelines (WCAG 2.1 AA)
• Providing all information in both English and Spanish
• Using plain language and clean design
• Centering the human experience with diverse and colorful illustrations
• Building the site to be responsive to different devices, including mobile phones and tablets
• Offering clear and multiple pathways for people to learn about their rights

When people visit the consumer website, they’ll be guided through:

• Understanding their rights under the No Surprises Act, including out-of-network billing protections and good faith estimates for future care
• Identifying actions they can take to exercise their rights and find a resolution if they receive an unexpected medical bill, using a Q&A tool that asks about their situation
• Submitting a complaint if they think their provider, facility, or insurance company didn’t follow the rules of the No Surprises Act through an optimized process and redesigned form
• Disputing a bill if they are uninsured or didn’t use insurance and they were charged more than their good faith estimate
• Finding guides that will help them navigate medical billing questions, as well as learning how to connect with the No Surprises Help Desk

Resources:

•  No Surprises Act Consumer Webpage: https://www.cms.gov/medical-bill-rights as well as en Español: https://www.cms.gov/derechos-facturas-medicas
• New Protections for Consumers: https://www.cms.gov/medical-bill-rights/know-your-rights
  Payment Dispute Webpage: https://www.cms.gov/medical-bill-rights/help/dispute-a-bill
• Submit a Complaint: https://www.cms.gov/medical-bill-rights/help/submit-a-complaint
• Find an Action Plan: https://www.cms.gov/medical-bill-rights/help/plan
• Resources for providers can still be found at: https://www.cms.gov/nosurprises

In a significant win for Community Health Centers and Medicaid recipients, the Supreme Court of the United States has ruled in favor of the right of people in safety net programs to seek federal court protection if their health care and other essential benefits are jeopardized. The Supreme Court overturned a lower court ruling in Health and Hospital Corporation of Marion County v. Talevski that curbed the rights of Medicaid beneficiaries to sue states. This landmark ruling has far-reaching implications for Community Health Centers and the millions of Medicaid patients who rely on them for medical care. The National Association of Community Health Centers (NACHC) played a key role in the case, filing an amicus brief urging the Court to uphold section 1983 and recognize its significance for the nation’s health centers.

The telemedicine bill was recently introduced and referred to the Banking and Insurance Committee. Senate Bill 739 has had many changes included since the version that was considered during the last legislative session. FQHCs are encouraged to review the newly introduced bill and provide PACHC with any concerns. The committee could potentially consider this bill in the later part of June. Contact Eric Kiehl, PACHC Director of Policy and Partnership with any feedback or concerns.

Legislation to extend a cost-of-living moratorium keeping thousands of senior citizens eligible for state prescription drug benefits despite increases in Social Security payments was approved Monday by a House committee. Read more.

NEW: CMS UNWINDING ANNOUNCEMENTS

CMS is committed to maximizing the number of people with affordable, high-quality coverage. We want to make sure people stay covered whether that’s through Medicaid, Medicare, the Marketplace, or employer-sponsored coverage. This work is all hands-on-deck and will continue to be. These announcements and resources below will help you reach Medicaid enrollees and help them complete their renewals and help connect them to other coverage as appropriate.

• CMS Press Release: HHS Takes Additional Action to Keep People Covered as States Resume Medicaid, CHIP Renewals
• Secretary Letter to Governors: This letter discusses HHS’ role in monitoring progress and enforcing compliance as well as flexibilities available for states to help ensure the process runs smoothly.
• Strategies to Prevent Procedural Terminations: This document describes multiple strategies states are encouraged to adopt to streamline renewals during the Unwinding period, minimize terminations for procedural reasons, and quickly reenroll eligible families who have lost coverage. It also highlights several new strategies CMS has recently made available to states.
• All Hands On-Deck: This fact sheet includes an update on Unwinding and strategies to help keep people covered.

PARTNER CALL TO ACTION

We are calling on states, members of Congress, the health care industry, community organizations, advocacy coalitions, and other public and private partners to do everything in their power to help people stay covered. Read more: All Hands On Deck: What YOU Can Do

NEW: MEDICAID.GOV UPDATES AND PARTNER RESOURCES

The Outreach and Educational Resources Page on Medicaid.gov/Unwinding has been updated to make it easier for partners to locate resources. Each resource includes recommendations on how they can be used to educate people about Medicaid and CHIP renewals. With the website update, you can find new resources for kids and families, fraud/scams, and educational videos included below.

Messaging and Resources for Kids and Families

• Post Card for Kids with Medicaid or CHIP (English and Spanish)
• Fillable Post Card for Kids with Medicaid or CHIP (English and Spanish)
• Post Card for Renewing Kids’ Medicaid or CHIP (English and Spanish)
• Fillable Post Card for Renewing Kids’ Medicaid or CHIP (English and Spanish)

Resources on Fraud/Scams

• Customizable Scam Alert Messages (English and Spanish)
• Social Media (English)

Educational Videos

Note: These videos can be used through February 22, 2024 and they cannot be used as PSAs.

Don’t Wait! Update! Get Ready to Renew Your Medicaid or CHIP Coverage (:30 Seconds):

• https://youtu.be/MFaBCH-hVB8 (English)
• https://youtu.be/atBHw_GD1ls (Español/Spanish)

Don’t Wait! Update! Get Ready to Renew Your Medicaid or CHIP Coverage (:15 Seconds):

• https://youtu.be/d5CAlr8PGl8 (English)
• https://youtu.be/cWj_5clH1Rc (Español/Spanish)

Don’t Wait! Update! Get Ready to Renew Your Medicaid or CHIP Coverage (:06 Seconds):

• https://www.youtube.com/watch?v=Rn3EjrxokxQ (English)
• https://www.youtube.com/watch?v=v2zziuthgjA (Español/Spanish)

UPCOMING PARTNER WEBINARS

HHS and CMS continue to host a series of monthly webinars on Medicaid and CHIP Continuous Enrollment Unwinding to educate partners. Topics covered during the webinar vary each month. Webinars take place the fourth Wednesday of each month from 12:00pm – 1:00pm ET. Register for upcoming webinars through September 2023 here.

Recordings, transcripts, and slides from past webinars can be found on the CMS National Stakeholder Calls webpage.

Across the United States, rural communities are transforming. Whether they’re lifting up local entrepreneurs, embracing art and beauty, or leaning into outdoor recreation to attract tourists, there are numerous examples of positive change. To share these stories, Tony Pipa hit the road and spoke with the people that are making it all happen.

Listen to the complete first season of Reimagine Rural wherever you get your podcast.

Looking for more?

Stories from the listeners. Only eight episodes of Reimagine Rural were planned, but we heard from so many listeners across the country that we had to release another one. Listen to a bonus episode with more stories of community revitalization.

Policy lessons and surprises. In this recap blog post, Tony Pipa shares some of the key takeaways from his conversations with local leaders, investors, and small-business owners.

The Centers for Medicare & Medicaid Services (CMS) announced a new primary care model – the Making Care Primary (MCP) Model – that will be tested in eight states. Access to high-quality primary care is associated with better health outcomes and equity for people and communities. The model seeks to improve care for people with Medicare and Medicaid by equipping primary care clinicians with tools to form partnerships with specialists and leverage community-based connections to address patients’ health and health-related social needs.

CMS plans to partner with State Medicaid Agencies in the eight states to engage in full care transformation across payers. The model will support participants with varying levels of accountable care experience, including Federally Qualified Health Centers (FQHCs) and physician practices with limited experience in value-based care, in driving toward a system that reduces disparities in care and results in better patient experience and outcomes.

CMS will test this advanced primary care model in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. CMS will work with model participants to address priorities specific to their communities, including care management for chronic conditions, behavioral health services, and health care access for rural residents.

Primary care organizations within participating states may apply when the application opens in late summer 2023. The model will launch on July 1, 2024.

For more information, review the detailed official press release.

To view the MCP webpage, visit: https://innovation.cms.gov/making-care-primary.

To view a model key highlights video, visit: https://youtu.be/8vy3PHHlCe4.