US No Surprises Act (42 USC 300gg-111 to 300gg-139) and 45 CFR Part 149 149.120: Cover non-emergency services of nonparticipating providers at participating facilities at in-network cost sharing unless valid notice and consent were given, with the same 30-day payment and accumulator duties

What does 149.120 require?

For items and services (other than emergency services) furnished by a nonparticipating provider during a visit at a participating health care facility, unless the provider satisfied the notice and consent criteria of 149.420(c) to (i), the plan or issuer must not impose cost sharing above the in-network amount, must calculate it as if the participating charge equalled the recognized amount, must within 30 calendar days of the complete claim send an initial payment or notice of denial, must pay the out-of-network rate less cost sharing directly to the provider within the statutory or State timing, and must count the cost sharing toward in-network deductibles and out-of-pocket maximums.