The federal departments of Health and Human Services (HHS), Labor and Treasury recently issued a frequently asked questions (FAQs) document regarding requirements for providers and health plans under the No Surprises Act and the Transparency in Coverage final rule.
Under the No Surprises Act, providers and facilities are required to prepare a “good faith estimate” of expected charges for the services the patient has scheduled. This includes expected charges for other providers and facilities used in the services. The notice is provided to the health plan or other source of coverage and will be required beginning Jan. 1, 2022.
The FAQ document says the HHS will not complete the necessary rulemaking to implement this provision of the No Surprises Act by Jan. 1 and will delay enforcement. However, the HHS does intend to do rulemaking to implement the requirement to provide an estimate of charges to patients who are not enrolled in health coverage or who will not be making a claim for services (i.e., paying out of pocket.)
The delay in enforcing the good faith estimate will also delay enforcement of the requirement that health plans and other sources of health benefits provide an “Advanced Explanation of Benefits” after they receive the estimate from the provider. The FAQs do not indicate when rulemaking will take place or estimate when enforcement will begin. For more information about these requirements and enforcement delays, contact Laura Appel at the MHA.