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| 1 minute read

New FAQs on No Surprises Act rules posted on CMS website

The Centers for Medicare & Medicaid Services (CMS) has updated its resource page regarding the requirements of the No Surprises Act enacted as part of the Consolidated Appropriations Act of 2021. 

Particularly useful are a pair of FAQs issued by CMS last week. Links to those FAQs are here and here.

Part 2 of the FAQs were 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-pay) patient. The following information in this FAQ is particularly helpful.

  • Is a provider or facility required to provide a GFE to uninsured (or self-pay) individuals upon scheduling same-day (or walk-in) services?  
    • No. HHS responds that the requirement to provide a GFE to an uninsured (or self-pay) individual is not triggered if the service is being scheduled fewer than 3 business days before the service is expected to be furnished.

  • What if a provider or facility did not provide an individual with a GFE at the time a service is scheduled because the patient was not uninsured (or self-pay) at that time, but the patient's insurance status has changed such that she is now uninsured (or self-pay). Must the provider or facility provide a GFE to the individual prior to providing the service, even if it means rescheduling to a later date? 
    • No. HHS answers that where a provider or facility who has previously determined that an individual was not uninsured (or self-pay) becomes aware that an individual is uninsured (or self-pay) fewer than 3 business days in advance of the scheduled furnishing of items or services, nothing in the GFE regulations require that the provider or facility provide a GFE to such an individual, or reschedule an appointment to allow for the provision of a GFE to such an individual.

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

For further information on the No Surprises Act and its good faith estimates requirement, I recommend you read our Reed Smith LLP Health Industry Washington Watch blog post.

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

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health care & life sciences, no surprises act, hhs, cms

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