On December 2, the CMS published an FAQ announcing that the agency further delayed enforcement of the good faith estimate (GFE) requirements for uninsured or self-pay individuals. The FAQ clarified that the Department of Health and Human Services (HHS) is extending enforcement discretion, pending future rulemaking, for situations where GFEs for uninsured (or self-pay) individuals do not include expected charges from co-providers or co-facilities. According to the HHS, they have received feedback that “compliance with this provision is likely not possible by January 1, 2023, given the complexities involved.” Importantly, they explain that any rulemaking to fully implement the GFE requirements related to uninsured (or self-pay) individuals will include a prospective applicability date that gives providers and facilities a reasonable amount of time to comply with any new requirements.

The GFE requirements were included in the No Surprises Act and intended to protect uninsured (or self-pay) individuals from unexpectedly high medical bills. When a physician/facility schedules an item or service (such as a medical device, a doctor’s visit, or a surgical procedure), it must determine the individual’s health insurance status. If the patient has no coverage (uninsured) or does not intend to submit a claim to the plan/coverage (self-pay), the physician/facility must provide notification to the patient of the good faith estimate (GFE) of expected charges.

In March of 2022, the CAP met with the CMS to try and obtain clarification and further guidance around these requirements. As we expressed in an April 2022 letter, “we see no clear way to proceed in providing prospectively reliable estimates for pathology services, as pathologists are not the initiator of the tissue or fluids submitted for diagnosis, and will know neither what will be submitted nor what will need to be done until the pathologist has reviewed the original specimen(s) from each individual patient.”

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