CLIENT ALERT: HHS Issues Guidance Clarifying GFE Requirements Under the No Surprises Act for Federally Qualified Health Centers
On December 27, 2022, the Department of Health and Human Services (HHS) issued a guidance document relating to the obligations of Federally qualified health centers (FQHCs) to issue a good faith estimate (GFE) to uninsured and self-pay patients under the No Surprises Act, which took effect on January 1, 2022. The guidance (FAQs about CAA, 2021 – GFEs for Uninsured (or Self-Pay) Individuals – Part 4) is a welcome clarification as to how providers using sliding fee discount policies (SFDP), such as FQHCs, may issue compliant GFEs. Perhaps most importantly, the guidance reaffirms that FQHCs are expected to comply with the GFE provisions of the No Surprises Act.
The No Surprises Act, Title I, Div. BB, of the Consolidated Appropriations Act 2021 (CAA 2021), was enacted on December 27, 2021, and most of its requirements took effect on January 1, 2022. The overall goals of the No Surprises Act were to reduce the prevalence of surprise medical bills for commercially insured patients, and to improve consumers’ access to information about the costs of health care services (“provider transparency”). The centerpiece of the provider transparency provisions of the No Surprises Act is the requirement to furnish a GFE for services, scheduled at least three days in advance, to uninsured or self-pay patients. (No Surprises Act § 112, PHSA § 2799B-6(2)(B); 45 C.F.R. § 149.610.)
The GFE requirement in the No Surprises Act particularly impacts FQHCs, given the high volume of services FQHCs furnish to uninsured and self-pay patients.1 GFEs are required to include the “expected charges” for items and services that the provider anticipates furnishing to the uninsured/self-pay patient. Questions have arisen as to how FQHCs can accurately provide “expected charges” for patients whom the FQHC has not yet had the opportunity to evaluate for purposes of applying its SFDP, as required by Section 330 of the Public Health Service Act. The new guidance reaffirms that FQHCs are required to furnish GFEs in compliance with the law, and provides several examples of how FQHCs can issue compliant GFEs, even in circumstances where the FQHC does not have sufficient information to determine whether or to what extent the fees for services will be discounted under the SFDP.
The guidance also clarifies that providers are required to issue to GFEs to uninsured and self-pay patients even where the provider will furnish the services free of charge. HHS clarifies in the guidance that only an “abbreviated” GFE is required in this circumstance, and the guidance includes a template for an abbreviated GFE.
[FTLF will be hosting a webinar on January 26 that will cover these new updates on HHS implementation of the No Surprises Act. Register here.]
For more information, contact Susannah Vance Gopalan at SGopalan@ftlf.com.
1 The law does contain a requirement similar to the GFE for commercially insured patients—an “advance explanation of benefits” that insurers, using information furnished by providers, will be required to provide to enrolled individuals in advance of services—but HHS has not yet implemented that provision of the law.