US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.110(b)(3): For out-of-network emergency services, apply in-network cost sharing calculated on the recognized amount, pay within 30 days and count the cost sharing toward in-network limits

What does 149.110(b)(3) require?

Where emergency services come from a nonparticipating provider or emergency facility the plan or issuer must not impose administrative requirements or coverage limits stricter than for participating providers; must not charge cost sharing greater than the in-network amount, calculated as if the participating charge equalled the recognized amount; must, within 30 calendar days of receiving the information needed to decide the claim, determine coverage and send an initial payment or a notice of denial of payment; must pay the provider or facility directly a total plan payment equal to the out-of-network rate less the cost sharing and any initial payment, within the statutory timing or the State-law timing; and must count the patient's cost sharing toward the in-network deductible and out-of-pocket maximum as if the services were in network.