On December 27, 2022, the Centers for Medicare and Medicaid Services (CMS) published a new FAQ regarding the good faith estimate (GFE) for providers treating uninsured or self-pay individuals. The GFE requirement is detailed in CMS regulations implementing the No Surprises Act, which sought to protect patients from surprise medical bills for uncovered services. The requirements to furnish GFEs for uninsured or self-pay individuals became effective on January 1, 2022.
The new FAQ clarifies CMS expects Federally Qualified Health Centers (FQHCs) and other providers and facilities that offer sliding fee discounts to comply with GFE requirements. CMS notes that under the GFE regulations, the expected charges must reflect any discounts but “recognizes that FQHCs and other providers and facilities offering sliding fee discounts face unique challenges in meeting these requirements” and, therefore, a provider doesn’t who does not have sufficient information about the patient to determine sliding discounts can simply list the undiscounted price in the GFE.
At the same time, CMS encourages sliding fee discount providers who take this approach to include information about their sliding fee schedule and any other financial protections offered. CMS also recommends including a disclaimer indicating that the estimate is based on currently available information and that actual charges may differ.
CMS also states that providers who know in advance that they do not expect to bill an uninsured individual can provide the individual with an abbreviated GFE that does not include expected charge information, as long as it complies with all other requirements of the rules.
See here for more details.