On Dec. 2, the Centers for Medicare and Medicaid Services (CMS) announced that it will delay enforcement of the No Surprises Act (NSA) requirement for convening providers and facilities to include cost estimate information from co-providers and co-facilities in the good-faith estimate (GFE) provided to uninsured (or self-pay) patients for scheduled items or services.
Enforcement of this requirement, which was due to go into effect on Jan. 1, 2023, will be delayed indefinitely pending further rulemaking.
This announcement comes as welcome news to providers across the country who have been struggling to develop and implement processes to allow them to request, and for co-providers and co-facilities (who may not be affiliated with the convening provider or facility) to provide, complete and accurate pricing information to include in the GFE. Numerous industry groups previously urged CMS to delay the implementation of this requirement, noting that the lack of any standardized processes to automate the exchange of this information imposed an undue burden on the provider community.
In the Dec. 2 announcement, CMS acknowledged industry comments which "indicat[ed] that compliance with this provision is likely not possible by Jan. 1, 2023, given the complexities involved with developing the technical infrastructure and business practices necessary for convening providers and facilities to exchange GFE data with co-providers and co-facilities." CMS further noted that "[s]takeholders have requested that HHS further delay the enforcement of this provision until HHS has established a standard technology or transaction to automate the creation of comprehensive GFEs and given providers and facilities sufficient time to implement such standards."
CMS states that in order to achieve industry-wide interoperability for the transmission of GFE data between convening providers and facilities and co-providers and co-facilities, it will be necessary to develop a standards-based application interface ("API") for this purpose, and that pursuing API-based standards for the exchange of GFE data is part of a larger strategy to encourage and support the adoption of health information technology to promote bi-directional data exchange to improve the quality of care and promote a more efficient health care system.
CMS states that future rulemaking on this issue will include a new prospective applicability date that will give providers and facilities a reasonable amount of time to comply with any new requirements. For the time being, providers who were apprehensive about meeting the Jan. 1, 2023 compliance deadline can breathe a sigh of relief.
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