CMS Delays Looming Good Faith Estimate Co-Provider Requirement
By Admin | December 05, 2022
The Centers for Medicare and Medicaid Services (“CMS”) published FAQ guidance on December 2, 2022 indefinitely extending the current enforcement discretion for non-compliance with the No Surprises Act requirement that Good Faith Estimates (“GFEs”) for uninsured or self-pay patients include expected charges from co-providers or co-facilities until future rulemaking is issued.
Since January 1, 2022, the law has required providers and facilities to issue a GFE of expected charges to uninsured and self-pay individuals upon request or at the time of scheduling a health care item or service. Importantly, the No Surprises Act and its implementing regulations also require each GFE to include expected charges for any item or service that is reasonably expected to be provided in conjunction with the scheduled or requested item or service, including those provided by co-providers or co-facilities. Please see Hall Render’s prior Client Alert for a more detailed discussion of this GFE requirement.
The Department of Health and Human Services (“HHS”) delayed enforcement of the GFE co-provider requirement for one year to allow providers and facilities to develop systems and processes for the exchange of required information between (i) the providers/facilities with which the primary service was initially scheduled or from which the GFE was initially requested and (ii) co-providers/co-facilities. That one‑year delay, however, proved insufficient as facilities and providers struggled for months to develop and implement solutions to comply with the GFE co-provider requirement in advance of the January 1, 2023 enforcement deadline, without any sub-regulatory or interpretive guidance from HHS.
In response to industry comments, HHS issued updated guidance in the form of an FAQ, which now delays enforcement of the GFE co-provider requirement until HHS issues additional guidance through formal rulemaking. This means there is no new enforcement deadline, and according to the FAQ, any future rulemaking will include...(More)
For more info please read, CMS Delays Looming Good Faith Estimate Co-Provider Requirement, by Hall Render - Blog - Health Law News