CMS Seeks Feedback on Good Faith Estimates

Nov 4, 2022

Attention Clinical Social Workers: CMS Seeking Feedback on Good Faith Estimates

The Centers for Medicare and Medicaid Services (CMS)  is seeking feedback from clinical social workers and other providers about how they should provide estimates for costs of services for patients who use their insurance to pay for health and mental health services.  Your feedback would be helpful in providing information to CMS who may create a proposed rule for preparing national standards in this area.

The request for feedback is related to the No Surprise Act (NSA), which protects patients from large, surprise healthcare bills. Clinical social workers (CSWs) are currently required to give Good Faith Estimates (GFEs) to patients who are uninsured and patients who have insurance but do not plan to use it.

Read “No Surprises Act Regulations 2022”

A future rule may add to the Good Faith Estimate requirements for patients who intend to use their insurance to cover their care.  CMS is proposing that the CSW will need to notify the patient’s health plan of their estimated charges.

The health plan would then send the patient an Advanced Explanation of Benefits based on the CSW’s estimate.

The request for information will help CMS propose detailed steps for sending GFEs from CSWs and other providers to the patient’s health plan.  There are a series of questions available for response.  You may respond to one or more of the questions.  Examples include:

  • What privacy concerns does the transfer of AEOB and GFE data raise?
  • What burdens or barriers would be encountered by small, rural, or other providers, facilities, plans, insurers, and carriers in complying with industry-wide standards for the exchange of information?
  • Would it alleviate burden to allow CSWs and other providers, for purposes of verifying coverage, to rely on a patient’s representation regarding whether the patient is enrolled in a health plan?

A list of additional questions is available at Request for Information: Advanced Explanation of Benefits and Good Faith Estimate for Covered Individuals.  The deadline for submitting feedback to CMS is November 15, 2022.

NASW will be submitting comments and requesting an exemption from the proposed requirement that clinical social workers issue GFEs to insurers, and advocating for less burdens.

NASW members may forward questions to Clinical.Practice@socialworkers.org

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