The Department of Health and Human Services (HHS) on Sept. 16 issued a request for information on the No Surprises Act’s advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements for insured individuals. The agency will consider input received in future regulatory proposals or guidance.
HHS seeks comment on transferring data from providers and facilities to health care plans, including:
- how to encourage use of specific interfaces to exchange AEOB and GFE data;
- privacy concerns related to data transfer; and
- burdens or barriers to small providers and plans in adopting technology standards for data exchange.
HHS also seeks comment on issues related to ensuring accurate AEOBs and how federal and state surprise billing laws affect an individual’s benefits and financial responsibility. Issues include:
- accurately accounting for and clearly communicating consent to waive balance billing protections;
- how AEOB requirements interact with Transparency in Coverage requirements;
- considerations for AEOBs and GFEs when individuals have multiple forms of health coverage, including Medicaid and Medicare;
- whether the provider should verify the patient’s enrollment status in health coverage for scheduled services, and additional burdens this may create; and
- ensuring that plans’ communication to covered individuals is accessible, linguistically tailored, and at the appropriate literacy level, while accounting for barriers underserved communities experience in implementing AEOB and GFE requirements.
Finally, HHS seeks comment on the economic effect of implementing AEOB and GFE requirements related to purchasing and implementing IT systems, as well as providing GFEs to plans.
Comments are due Nov. 15.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.