On September 10, the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor (DOL) and the Office of Personnel Management (OPM) released a second rule implementing the No Surprises Act (NSA), the comprehensive federal law banning balance bills in emergency and certain non-emergency settings beginning January 1, 2022. This Notice of Proposed Rulemaking (NPRM) details the data on air ambulance services that must be reported to HHS and the Department of Transportation (DOT) and discusses the departments’ proposed approach to enforcement of the NSA. Beyond the NSA provisions, the NPRM also provides guidance on new federal requirements that individual market and short-term plan insurers disclose broker compensation to current and potential enrollees as well as to HHS. Comments on the NPRM are due October 18, 2021. This expert perspective summarizes the provisions of the NPRM and notes particular implications for state regulators and marketplace officials.