HHS Gives Providers More Time for Good Faith Estimate Compliance

HHS has extended enforcement discretion for the delivery of some good faith estimates (GFEs) under the No Surprises Act, according to new guidance.

The guidance released by HHS on Friday says that CMS will not begin enforcing the No Surprises Act requirement that healthcare providers deliver GFEs to uninsured and self-pay individuals when there are co-providers or co-facilities. Enforcement of the No Surprises Act requirement was slated to start on Jan. 1, 2023. Instead, HHS is holding off on enforcement until future rulemaking.

GFEs are price estimates for any item or service that is reasonably expected to occur during a scheduled procedure or requested item or service. The estimates include any items or services that may involve providers or facilities outside of the one scheduling the service. These co-providers and co-facilities, as they are named in the regulations, must submit GFE information within one business day of a convening provider’s request.

However, industry groups have expressed concerns about getting GFEs, including co-provider and/or co-facility price estimates, to patients within the statutory timeframe, which is three days after an individual requests the price estimate or after the service is scheduled. The groups have cited administrative burden and data exchange limitations as reasons why HHS should modify or revisit GFE requirements.

“By extending this exercise of enforcement discretion, HHS aims to promote further interoperability across the [healthcare] industry and encourage providers, facilities, and other industry members to focus resources towards adopting interoperable processes for exchanging information,” the guidance states.

HHS believes that healthcare providers and facilities will need to widely adopt “a standards-based application programming interface (API)” in order to “achieve industry-wide interoperability for the transmission of GFE data between convening providers and facilities and co-providers and co-facilities.” The Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard could support the interoperability providers need to deliver full GFEs to individuals, the federal department adds.

“The industry continues to make progress in developing data interchange standards to support the requirements of the No Surprises Act,” Charles Stellar, president and CEO of the Workgroup for Electronic Data Interchange (WEDI), said in a statement.

A survey conducted by WEDI earlier this year found that about 92 percent of providers thought that it would at least be difficult, if not very difficult, to collect GFE information from co-providers and/or co-facilities for a specific medical service. Nearly 66 percent also said it would be difficult to determine who the convening provider or facility is and 89 percent said it would be difficult for the convening provider to identify all co-providers and/or co-facilities.

“We commend HHS for extending the enforcement discretion period and averting significant administrative burdens on providers. The HHS action today grants the time necessary to develop [cost-efficient] solutions and implement supporting regulations,” Stellar said.