New No Surprise Billing Regulations for Behavioral Health Care Providers

Starting January 1, 2022, behavioral health care providers will be required by law to give uninsured and self-pay clients a good faith estimate of costs for services when scheduling care or when the client requests an estimate.

The No Surprises Act aims to increase price transparency and reduce the likelihood that clients receive a “surprise” medical bill by requiring that providers inform clients of an expected charge for a service before the service is provided. The government will also soon issue regulations requiring behavioral health providers to give similar good faith estimates to commercial or government insurers, when the client plans to use medical insurance.

Consumers will also have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs will be restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

This new requirement was finalized on October 7, 2021. These regulations implement part of the “No Surprises Act,” originally enacted in December 2020 as part of a broad package of COVID-19 and spending-related legislation. This consumer protection legislation is aligned with professional counseling ethics regarding our duty to promote client welfare and protect against potential harm. The ACA Code of Ethics (Section A.2.b) stipulates that counselor must inform their clients about fees and billing practices.

To learn more about the No Surprise Act or to become involved in ACA’s advocacy efforts, please go to advocacy@counseling.org for more information.