No Surprises, New Developments: HHS Releases Third Annual No Surprises Act Report Highlighting Early Market Trends

On February 9, 2026, the U.S. Department of Health and Human Services (“HHS”), through the Office of the Assistant Secretary for Planning and Evaluation (“ASPE”), released its Third Annual Report evaluating the impact of the No Surprises Act (“NSA”) on health care market outcomes. The report examines trends in the health care marketplace following implementation of the NSA’s surprise billing protections and dispute resolution framework. As the third in a series of five congressionally mandated reports, the evaluation offers a developing picture of how the NSA may be shaping provider network participation, reimbursement negotiations, and broader market dynamics across the health care system.

 A copy of the report is available here.  

Background on the No Surprises Act

The NSA, enacted in December 2020 and effective January 1, 2022, was designed to protect patients from unexpected out-of-network medical bills, particularly in circumstances where patients have limited ability to select their provider. Where it applies, the NSA prohibits health care providers from balance billing patients for the difference between a provider’s charges and the amount paid by the patient’s health plan for certain services, including emergency services, non-emergency services furnished by out-of-network providers at in-network facilities, and air ambulance services. To address payment disputes arising from these protections, the NSA also established a federal Independent Dispute Resolution (“IDR”) process, which allows providers and health plans to submit payment offers to a certified arbitrator for resolution in a “baseball” style arbitration.

In addition to the patient protections and IDR process, the NSA also introduced new transparency requirements, including obligations for providers to furnish good faith estimates of expected charges for uninsured or self-pay patients. HHS’s latest report evaluates how these core features of the statute (including the IDR framework and related market reforms) are influencing provider participation, reimbursement negotiations, and broader health care market dynamics in the years following the law’s implementation.

Key Observations from HHS’s Third Annual Report

HHS’s latest report analyzes early market outcomes following implementation of the NSA and highlights several emerging trends that may shape how providers and health plans approach reimbursement and network participation going forward. According to the report, provider network participation patterns appear to be evolving as the industry adjusts to the new reimbursement framework created by the law. Some specialties historically associated with surprise billing may be reassessing their contracting strategies considering the NSA’s billing restrictions and dispute resolution mechanisms. Although the available data remains preliminary, the report suggests that the statute may already be influencing how providers and health plans approach network negotiations and reimbursement arrangements. Early indicators suggest that some providers may be reassessing out-of-network participation strategies, while payers and providers alike appear to be recalibrating in-network reimbursement rates considering IDR outcomes as well as ongoing development to the legal frameworks governing the IDR framework. These early signals are particularly relevant for stakeholders navigating contracting strategies, reimbursement expectations, and dispute resolution planning in the post-NSA environment.

The report also examines changes in reimbursement dynamics. HHS notes that the existence of the federal IDR process may be affecting negotiations between providers and health plans, potentially influencing payment expectations for services commonly involved in surprise billing disputes. In practice, the IDR framework functions not only as a dispute resolution mechanism but also as a backdrop for payer-provider negotiations, shaping how parties evaluate the risks and potential outcomes of arbitration. While the report does not reach definitive conclusions regarding the long-term effects of the law on reimbursement levels, it indicates that the federal dispute resolution framework is becoming an increasingly significant factor in negotiations across the health care marketplace.

At the same time, HHS emphasizes that the findings reflected in the report represent only an early snapshot of market behavior. Because the NSA has been in effect for a relatively short period, HHS cautions that additional data will be necessary to fully understand the law’s long-term impact on health care markets. The remaining reports in the five-year congressionally mandated series will continue to examine trends in network participation, reimbursement levels, and contracting dynamics as the regulatory framework matures and stakeholders gain more experience with the IDR process and related transparency requirements. For industry participants, these annual reports may serve as an increasingly important resource for understanding how federal regulators are evaluating the law’s impact and how policy discussions surrounding the NSA may evolve.

What’s Coming Up Next? Preliminary Findings with More to Come

HHS’s third annual evaluation offers an early but still incomplete view of how the NSA may be influencing the structure of the health care marketplace. Although the report identifies several areas of potential impact (including reimbursement negotiations, network participation, and IDR utilization), it stops short of drawing definitive conclusions, reflecting the limitations of the current data. In particular, the report does not yet provide sufficient longitudinal or market-wide evidence to determine whether the NSA is driving sustained shifts in network participation (e.g., increased out-of-network positioning) or meaningfully altering in-network rate setting across provider categories. This lack of clarity underscores both the relative infancy of the statute’s implementation and the complexity of isolating NSA-driven effects from broader market dynamics. As a result, while the report is directionally informative, it leaves several of the most consequential questions about payer-provider behavior unanswered. Accordingly, as the market landscape continues to develop, stakeholders should continue to monitor regulatory guidance, emerging dispute resolution trends, and evolving reimbursement practices to ensure ongoing compliance with the NSA.

HaloMD is actively monitoring developments related to the No Surprises Act and its implementation. For additional insights into this and related regulatory developments, visit our News & Resources page.