Kansas (Kansas) does not have its own standalone surprise billing law that supersedes or replaces the federal No Surprises Act (NSA). Prior to the NSA, Kansas had limited protections related to emergency care and insurance disclosures, but nothing constituting a CMS-recognized state-level payment or arbitration system.

Beginning January 1, 2022, the federal NSA became the controlling law governing all out-of-network (OON) reimbursement disputes for most commercial plans in Kansas.

Kansas does not maintain its own benchmark pricing method or state-level independent dispute resolution program.

Kansas applies the federal NSA for all surprise billing scenarios. Under this framework:

• Patients may not be balance billed for covered OON emergency services.
• Patients cannot be balance billed for non-emergency OON services performed at an in-network facility, unless federal notice-and-consent rules apply.
• OON providers must submit claims to the health carrier, not the patient.
• Insurers must issue an initial payment based on the federally required Qualified Payment Amount (QPA).
• Patients pay only their in-network cost-sharing amounts.

Kansas does not create supplemental requirements for payment methodology.

Kansas does not operate a state-based IDR system and has no Specified State Law (SSL) recognized by CMS.

Therefore:

• The Federal NSA IDR system applies to all eligible OON reimbursement disputes.
• This includes:
  
  • Emergency OON claims
  • Non-emergency OON care at in-network facilities
  • Air ambulance services
  • Any dispute involving QPA-based initial payments

There is no Kansas alternative arbitration process for OON disputes.

Kansas follows the federal NSA’s negotiation rules:

• The insurer issues an initial payment or denial.
• A 30-day open negotiation window begins, requiring good-faith discussions.
• If no agreement is reached, either party may file for Federal IDR.

Kansas adds no state-specific negotiation or timing requirements.

Since Kansas relies exclusively on the federal IDR process, arbitrators consider:

• Qualified Payment Amount (QPA) — primary benchmark
• Provider training, experience, and patient acuity
• Facility characteristics and case complexity
• Contracting history between the parties (past four years)
• Market share of provider and carrier
• Good-faith contracting behavior

Kansas does not impose additional criteria beyond these federal standards.

Kansas surprise billing protections rely on:

• Kansas Insurance Department enforcement
• General prohibitions on unfair or misleading billing practices
• Adoption of federal NSA requirements under 45 CFR 149.510 & 149.520

Kansas does not create a state-defined OON payment methodology or arbitration process.

CMS has confirmed that Kansas does not maintain a Specified State Law (SSL).

• Fully insured commercial plans
• Individual market plans
• Group plans
• Self-funded ERISA plans (unless adopting another SSL — extremely rare)

• The QPA controls OON payment determinations.
• All arbitration is done via Federal IDR.
• Kansas carriers must follow federal payment and negotiation timelines.
• Kansas law enhances patient protections but does not modify OON reimbursement mechanics.