New No Surprises Law Rules FAQ posted on CMS website

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The Centers for Medicare & Medicaid Services (CMS) has updated its resource page regarding the requirements of the unsurprising law enacted as part of the Consolidated Appropriations Act of 2021.

A pair of FAQs published by CMS last week are particularly helpful. Links to these FAQs are here and here.

Part 2 of the FAQ was prepared by the Department of Health and Human Services (HHS) to address the provision of a Good Faith Estimate (GFE) for an uninsured (or self-paid) patient. The following information in this FAQ is particularly useful.

  • Is a provider or facility required to provide GFE to uninsured (or paying) individuals when scheduling same-day (or walk-in) services?
    • Nope. HHS responds that the requirement to provide a GFE to an uninsured (or self-paid) individual is not triggered if service is scheduled less than 3 business days before service is scheduled.
  • What if a provider or facility did not provide GFE to a person at the time a service was scheduled because the patient was not uninsured (or self-paid) at that time there, but the patient’s insurance status has changed such that she is no longer insured (or self-pay). Should the provider or facility provide a GFE to the person before providing the service, even if it means postponing it to a later date?
    • Nope. HHS responds that when a provider or facility that has previously determined that an individual is not uninsured (or self-paid) becomes aware that an individual is uninsured (or self-paid) less than 3 business days prior to the scheduled provision of the items or services, nothing in the GFE regulations requires the provider or establishment to provide a GFE to such person, or reschedule an appointment to allow for the provision of a GFE to such a person.

HHS provides additional questions and answers on whether to provide estimates of expected future charges when the uninsured or self-paying patient receives a GFE at the initial visit for recurring services. HHS has indicated in the FAQs that patients may receive additional GFEs on future visits, or that the provider or facility (under certain circumstances) may provide a single GFE for recurring visits.

For more information on the No Surprises Act and its Good Faith Estimate requirement, I recommend reading our Reed Smith LLP Health Industry Washington Watch blog post.

Among other things, these include prohibiting balance billing in certain circumstances and requiring disclosure of balance billing protections, requiring transparency regarding health care costs, providing protections to consumers related to continuity of care and establishing requirements for provider directories.

www.cms.gov/…


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