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.