February 1, 2023

Volume XIII, Number 32

Advertisement

January 31, 2023

Subscribe to Latest Legal News and Analysis

January 30, 2023

Subscribe to Latest Legal News and Analysis
Advertisement

CMS Extends Delayed Enforcement of the Good Faith Estimate

On Friday, December 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued an FAQ regarding the Good Faith Estimate (GFE) and Convening Provider/Facility requirements in the Federal No Surprises Act. The issued document includes one key question we have all been wondering:

  • Will CMS enforce the requirement that GFEs for uninsured (or self-pay) individuals include cost estimates from co-providers and co-facilities beginning on January 1, 2023?

In sum (and to everyone’s relief) the answer is no. The United States Department of Health and Human Services (HHS) is extending enforcement discretion “pending future rulemaking.”

The FAQ goes on to discuss the technological challenges associated with exchanging data needed for the GFE. CMS listed the next step as providers and facilities adopting “a standards-based application programming interface (API) for this purpose,” such as the Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard. CMS noted that any future rulemaking to implement the GFE requirements will have a prospective applicability date.

However, health care providers (i.e., a physician or other health care provider acting in the scope of a license) and health care facilities (i.e., an institution, including hospitals, critical care hospitals, ambulatory surgery center, rural health center, federally qualified health center, lab, and imaging centers in any state where such an institution is licensed or approved by a state or locality) are still required to provide GFEs of expected costs for uninsured (self-pay) individuals or their authorized representative (the uninsured individual) when an item or service is scheduled or upon request of the uninsured individual.

© 2023 Foley & Lardner LLPNational Law Review, Volume XII, Number 341
Advertisement
Advertisement
Advertisement

About this Author

Alexandra Shalom Health Care Lawyer Foley Lardner
Associate

Alexandra (Allie) Shalom is an associate and health care business lawyer with Foley & Lardner LLP, and a member of the firm’s Health Care Practice Group.

Allie's practice focuses on counseling clients in the health care, pharmacy, and medical device industries with respect to a wide range of regulatory and compliance matters. Her experience includes advising clients on Medicare and Medicaid reimbursement; internal investigations; managed care and value based payment arrangements; self-disclosures; federal and state fraud and abuse compliance; and state licensure issues. She also...

617-502-3272
Kara Sweet, Health Care Lawyer, Foley & Lardner law Firm, Denver
Associate

Kara Sweet is a health care lawyer with Foley & Lardner LLP and member of the firm’s Government Enforcement, Defense, and Investigation Practice and Telemedicine & Digital Health Industry Team.

Kara works with hospitals and health systems, physician practice groups, pharmacies, durable medical equipment companies, laboratories, and emerging technology companies across the country. Her work focuses on federal and state health care regulatory compliance, conducting internal investigations, and defending government investigations and...

720.437.2002
Lawrence W. Vernaglia, Health Care Attorney, Foley Lardner Law Firm
Partner

Lawrence Vernaglia is a partner and health care lawyer with Foley & Lardner LLP and serves as chair of the firm’s Health Care Industry Team – named “Health Law Firm of the Year” for three of the past four years on the U.S. News - Best Lawyers® "Best Law Firms" list. Mr. Vernaglia represents hospitals, health systems and academic medical centers and a variety of other health care providers. Mr. Vernaglia's practice involves regulatory and transactional matters, including Medicare/Medicaid reimbursement compliance advice and appeals; mergers, acquisitions and...

617-342-4079
Advertisement
Advertisement
Advertisement