WEDI calls on HHS to soften good-faith estimate requirements

The requirement in the No Surprises Act is challenging to meet when multiple providers support care, and data exchange standards are lacking.

In a comment letter addressing the No Surprises Act, WEDI contends that the industry will need more time to provide patients with good faith estimates for medical services.

Specifically, WEDI’s letter to the Department of Health and Human Services says the healthcare industry does not have the technology tools and coordination of information among multiple providers who work together on complex care cases.

The professional organization, which advises federal agencies on data exchange issues, based its comments on a survey it had conducted earlier this summer. Results from the survey indicated that requirements for providers to give an estimated cost of patients’ medical services will be difficult to meet, particularly when multiple organizations are involved in a patient’s care. The No Surprises Act require good-faith estimates to be provided to patients or their health plans within three days of being requested or the service being scheduled.

Meeting the requirements of the No Surprises Act, which was included as part of a Consolidated Appropriations Act passed late in 2020, will be challenging because there is no standardized process to enable the exchange of cost information among facilities, WEDI notes.

HHS has indicated that it does not plan to strictly enforce some provisions for required good faith estimates (GFE) – which it calls enforcement discretion – until January 1, 2023 for uninsured and self-pay patients.

“The results of our survey support that providers and facilities will face significant challenges just identifying who the convenor should be, who the appropriate co-providers/facilities should be, and how to collect GFEs from these co-providers/facilities,” the WEDI letter notes. “Survey respondents were in overwhelming agreement that meeting the legislation’s three business day deadline to get the GFE to the patient would be difficult or very difficult.

“Respondents also expressed strong support for the government delaying the convenor requirement until a standardized process to exchange data between convening providers and co-providers/co-facilities is established. With these survey results in mind,” the letter adds.

WEDI’s comment letter suggested the following recommendations:

  • Consider an initial phase initiated by a patient request, thus limiting the requirement to instances where the patient has requested an estimate.
  • Extend the enforcement discretion period beyond the end of this year.
  • Identify standards-based solutions, with the letter suggesting that HHS work with WEDI “to establish an appropriate standard for conveying provider/facility information.”
  • Phase in the requirement for when co-providers must get back to the convening facility with their portion of the GFE.
  • Consider offering web-accessible “shoppable services” as an interim step on their publicly accessible websites.
  • Give providers and facilities the option of identifying co-providers for the patient, but not bear the sole responsibility for providing good-faith estimates.
  • Permit initial informal encounters before requiring a complex GFE or otherwise encourage dialogue between the patient and provider.
  • Address convening provider issues through guidance from HHS.

Read the full letter to HHS from WEDI.

No Surprise Act resources from WEDI

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