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HHS & other Federal Agencies Delay the Co-Provider Requirement for Good Faith Estimates

Big news: HHS announced earlier this week (in a FAQ, here) that it will not require "co-providers" to submit their charges in connection with Good Faith Estimates (GFE). HHS indicated for the first time that it will exercise its "enforcement discretion" as to this requirement beyond January 1, 2023.


HHS concluded that it is "likely not possible . . . given the complexities involved with developing the technical infrastructure and business practices necessary" for all providers to comply with this requirement by January 1. The requirement will be implemented with future rulemaking, but not until "providers and facilities market-wide []adopt a standards-based application programming interface (API) for this purpose."


In other words, CMS will not enforce the co-provider requirement until providers' EMRs learn to talk to each other in a way that enables them to seamlessly share a cost estimate for scheduled services.


Convening providers continue to have an obligation to provide GFEs to uninsured or self-pay patients, as explained in our prior posts here and here. HHS also continues to work on the rules for GFEs as they apply to patients with health insurance coverage. The period for responding to the federal agencies' Request for Information on that topic closed just a few weeks ago.


For information on how your organization can best comply with the GFE requirement and other No Surprises Act requirements, please contact Eric Chan at eric@athenelaw.com or (310) 913-4013.


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