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.
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.