CMS extends enforcement discretion on No Surprises Act 'convening provider' rule indefinitely

by: Roy Edroso Dec 6, 2022

Just a few weeks after closing out a Request for Information on its No Surprises Act (NSA) rules, CMS has given anxious providers an early holiday gift: An extension of its enforcement discretion on the convening provider requirements that are part of the Good Faith Estimates (GFE) providers must create for patients.

The GFE rules require providers to work up an honest and accurate estimate for patients who are receiving care from them outside their insurance network or who have no insurance. Where appropriate, these rules also require GFEs to cover not only the provider’s own services but those of downstream providers expected to be needed to complete treatment – aka, the "convening provider" requirement.

So many providers (and the organizations that represent them) have reported trouble understanding and following this requirement that HHS had declared it would employ discretion in enforcing them through the end of 2022. Now, in an FAQ revision published Dec. 2, CMS announces that “HHS is extending enforcement discretion, pending future rulemaking, for situations where GFEs for uninsured (or self-pay) individuals do not include expected charges from coproviders or co-facilities” until further notice.

As Part B News reported on Dec. 1, the convening provider requirement was high on the wish lists of health care organizations responding to the RFI request (PBN 12/2/22, subscription). Follow further NSA developments in future issues of Part B News.

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Blog Tags: CMS, compliance

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