Enforcement discretion extended for some No Surprises Act requirements

CMS extended enforcement discretion, pending future rulemaking, for providing good faith estimates (GFE) for uninsured or self-pay patients that include price estimates from co-providers or co-facilities. The agency announced the pause in a December 2 FAQ, citing technical limitations.

The 2021 Requirements Related to Surprise Billing; Part II interim final rule (IFR) discussed the roles of the convening provider and facility (the provider or facility that receives the request for the GFE and would perform and schedule the primary service) and the co-provider and co-facility. According to the IFR, the convening provider or facility is responsible for providing a GFE that includes expected charges from any co-providers or co-facilities that would be involved in the care. The IFR also enacted an enforcement discretion period for this requirement that would have expired January 1, 2023.

CMS believed that a year would be enough time to allow organizations to develop and implement processes to allow convening providers and facilities to request and receive complete and accurate pricing information from co-providers and co-facilities. However, after receiving feedback from stakeholders, the agency acknowledged that’s not realistic. It concurs with stakeholders that due to the current state of interoperability in the healthcare industry and the complexities involved in developing technology and infrastructure that support the seamless exchange of this data, more time and additional guidance are needed.

With enforcement discretion extended, organizations have more breathing room to continue to work toward solutions. If there are facilities and providers that routinely collaborate with your organization to provider patient care, it may be best to focus efforts on improving data exchange with them first. Discuss possible solutions with vendors and continue to advocate for sound, modernized data infrastructure. Taking these steps will put you and your organization in the best position to provide meaningful feedback on future rulemaking—as well as improving patients’ financial experience.

Editor’s note: Find more NAHRI resources on the No Surprises Act here.