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Update from COPACT on No Surprises Act

09 Jan 2022 1:56 PM | Support Coordinator (Administrator)


Hello all,

Please see the below information on the No Surprises Act from the COPACT Board.


COPACT: Info on the No Surprises Act & Good Faith Estimate

NOTE: This is NOT legal advice. This is information from an ethics CE that COPACT is relaying to Oregon clinicians. There seems to be new/more information everyday, so be aware that this information may be updated. The forms from HHS/CMS are "models" or "templates" to be used and are subject to change. These are not definitive answers at this time, rather a guide on how to start understanding and implementing this law into your practices. As clinicians, we are currently attempting to make a good faith effort and there is no perfect answer.

Yes, this is meant for LMFTs, LPCs, LMFT Associates, LPC Associates, etc., and not just Psychologists.

If the No Surprises Act is news to you, please catch up here

All of our info below came from a training by Becky Beaton-York, PhD & Ethicist from The Knowledge Tree and her malpractice insurer The Trust, who is not affiliated or partnered with COPACT or ORCA. 

AAMFT has a blog post here.

First and foremost, the biggest issue:

We know that we cannot ethically predict how long treatment for a client will take. The Good Faith Estimate (GFE) is just a fee structure for a year of sessions to give clients an idea of what they’re about to spend, so they’re not hit with surprise medical or mental health bills that they cannot afford (hence, No Surprise Act). It’s a way to be more transparent about your fees with clients (yes, even though it’s probably already on your Informed Consent & Fee Agreements).


Acronyms to know before reading this:

OMB = Office of Management & Budget

HHS = U.S. Dept. of Health & Human Services

GFE = Good Faith Estimate


Takeaway & things to know:

So far (and this could absolutely change, even in the days ahead) this is meant for clients who are uninsured or using cash pay/out of pocket (whether they are insured or not)

Just because there is a grace period and it won’t likely be enforced until July 1, 2022, we need to start complying with the law and ethics of this ASAP

If you don’t have a Tax ID number (EIN), it’s a good idea to get one now

Ask each client if they have insurance or plan to use it for your sessions

Your Good Faith Estimate (GFE) must be a separate document from your Informed Consent

You must give any new clients and existing clients this GFE within 3 days of their next appointment/ASAP

You do not need to give a diagnosis or diagnosis code on this GFE document

If we don’t provide this form, we can potentially be fined by a licensing board

Clients sign this even though it’s not a contract, and you’ll keep it in their file for 7 years just like clinical records

You must also go over the GFE verbally with clients

Use the existing forms from HHS to avoid pitfalls and fill it out specifically to your practice/work (OMB Control Number 0938-1401, per HHS)


Your GFE with your client will include:

-    A letter and 2 main forms:

-    Letter: Model Disclosure Notice Regarding Patient Protections Against Surprise Billing

-   Forms: Standard Notice & Consent Document with 1) Surprise Billing & Protection Form and 2) Good Faith Estimate

-   Various CPT codes and their cost per session

-    Estimate for 1 full year of sessions - do this GFE annually - if a client plans to attend monthly, create a specific GFE for them

-    The estimate amount must be within $400 of the actual cost (cannot exceed it)

-    Any time you increase your fees, you must create a new GFE for each client


You will need to post this form to your website and/or in your office physically:

Form: Model Disclosure Notice Regarding Patient Protections Against Surprise Billing


Forms in other languages?

The HHS has not uploaded forms in anything other than English unfortunately.


What is next?

There may be a Part 2 rolling out after March 31, 2022 from HHS and OMB.


Resources:

Training by Becky Beaton-York, PhD & Ethicist from The Knowledge Tree and her malpractice insurer The Trust

AAMFT Blog Post


Click here for a template for a Good Faith Estimate form *note that this document may have formatting issues

Click here for a template for a Standard Notice and Consent form

Click here for a template for a Letter to Clients

Click here for a Website Office Disclosure Notice form


If you have further questions or comments, please Contact COPACT.


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