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CMS Delays Enforcement of Good Faith Estimate Co-Provider Requirement

On Friday, December 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued an FAQ further delaying enforcement of a provision of the Federal No Surprises Act requiring Good Faith Estimates (GFEs) provided to uninsured or self-pay individuals to include cost estimates from co-providers and co-facilities beginning January 1, 2023.

Based on comments and feedback received by the healthcare industry, the Department of Health and Human Services (HHS) determined that compliance with this provision is not possible by January 1 “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.” As such, HHS has agreed to further delay the enforcement of this provision until these technological challenges are addressed. A new enforcement date will be determined by future rulemaking.

It is important to note that the delayed enforcement applies only to the requirement that the GFE must include cost estimates from co-providers and co-facilities. Healthcare providers and facilities are still required to provide GFEs of expected costs to uninsured or self-pay individuals upon request or upon the scheduling of items or services.

For additional information and resources on navigating the various provisions of the No Surprises Act, visit the KMA website.

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