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December 21, 2022

Delayed Enforcement of No Surprises Act Provider GFE Co-Provider Requirement

On December 2, CMS published FAQ guidance indefinitely extending the current enforcement discretion for non-compliance with the No Surprises Act’s requirement that provider Good Faith Estimates (“GFEs”) for uninsured or self-pay patients include expected charges from co-providers or co-facilities until future rulemaking is issued. 

Since January 1, 2022, the law has required providers and facilities to issue a GFE of expected charges to uninsured and self-pay individuals upon request or at the time of scheduling a health care item or service. The No Surprises Act and its implementing regulations also require each GFE to include expected charges for any item or service that is reasonably expected to be provided in conjunction with the scheduled or requested item or service, including those provided by co-providers or co-facilities. However, In response to industry comments regarding the substantial technical infrastructure and business practice complexities, CMS has now delayed enforcement of the GFE requirement to include expected charges for services provided by co-providers until HHS issues additional guidance through formal rulemaking.

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