A brief look into the Good Faith Estimate rules of the No Surprises Act, the National Crisis Hotline, and the New Act Promoting Mental Health among Health Care Professionals
By ERICA A. ERMAN
No Surprises Act: Behavioral Health Considerations Regarding the Good Faith Estimate Provisions
With the passage of the No Surprises Act, effective January 1, 2022, providers and facilities are now required to provide Good Faith Estimates to uninsured and self-pay individuals detailing the cost of the primary service or item needed and the cost of services or items that are customarily provided in conjunction with that primary item or service. This is relevant across the entire health care sphere, but is of particular importance in the behavioral health care world because many behavioral health patients are uninsured or choose to self-pay.
The requirements of the Good Faith Estimate provisions are triggered when an individual is either (1) scheduling a procedure or service, or (2) asking for information about a service or procedure—even if it is not being scheduled at that time. No magic words are required; after asking the individual if they are uninsured or planning on not using their insurance—if the individual says yes—the provider or facility must inform the individual of the availability of a good faith estimate of expected charges.
The provisions include strict timelines for the “convening” provider or facility, which is the name given for the provider/facility that is providing the primary item or service. The convening provider/facility must contact all co-providers/facilities reasonably expected to provide items or services in conjunction with the primary item or service within one day of scheduling the service or receiving the request for information from the individual. The co-provider/facility is then required to submit their estimate information back to the convening provider/facility no later than one business day after receiving the request.
There are also quick timing requirements for the providers/facilities to get back to the individual who scheduled the service/procedure or asked for the information. When the primary item or service is scheduled at least three business days before the date the item or service is scheduled to be furnished, the provider/facility must provide the estimate to the individual no later than one business day after the date of scheduling. If the primary item or service is scheduled at least 10 business days before the scheduled date of furnishing, or if the individual requested information without scheduling anything, the provider/facility must provide the estimate to the individual no later than three business days after the day of scheduling or receiving the request.
The notice itself has specific requirements and CMS has provided examples of how the Notice forms can be structured, which can be found here: https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10791. The key here is that the notices must be accessible. They must be accessible visually, meaning they must be prominently displayed. They must be accessible audibly, meaning the provider or facility is required to explain the estimates orally if the individual asks questions about the cost of the items/services. Moreover, the estimates must be accessible in the language spoken by the individual. There are specific notices and disclaimers required as well, as detailed in 45 CFR 149.610(c)(1) for convening providers/facilities and in 45 CFR 149.610(d) for co-providers/facilities.
HHS has advised that prior to December 31, 2022, by which time providers and facilities are expected to have a system in place to quickly provide these estimates to patients or requesting individuals, convening providers and facilities can (and should) include a range of expected charges for items or services reasonably expected to be provided and billed by co-providers and co-facilities. This law is in effect now.
New Digits for National Crisis Hotline
Our National Crisis Hotline is getting new digits this summer. After July 16, 2022, anyone can dial 9-8-8 and be connected to the National Crisis Hotline/Suicide Prevention Hotline. It’s the 9-1-1 for mental health. The current number, 1-800-273-8255 (1-800-2730-TALK), will continue to remain operational before, during, and after the 9-8-8 number becomes available nationwide. A chat feature is also available at https://suicidepreventionlifeline.org/chat/, but there may be longer wait times.
Dr. Lorna Breen Health Care Provider Protection Act
Signed into law on March 18, 2022, the Dr. Lorna Breen Health Care Provider Protection Act aims to help prevent suicide among medical professionals, to offer support and training for medical professionals struggling with mental health, and to provide grants, commission studies, and promote educational campaigns to these ends. These measures cannot come too soon – according to an article from Columbia University Irving Medical Center, one in five health care workers quit their job during the pandemic, 400 physicians in the USA die by suicide every year, and 60% of emergency doctors feel burned out. See “Dr. Lorna Breen Health Care Provider Protection Act Signed Into Law,” Columbia University Irving Medical Center, https://www.cuimc.columbia.edu/news/lorna-breen-health-care-provider-act-signed-law (March 18, 2022).
The Act includes a requirement for U.S. Department of Health and Human Services (HHS) to disseminate, within two years, best practices for preventing suicide and improving mental health and resiliency among health care professionals, and also for training health care professionals in appropriate strategies to promote their mental health. The Act also requires HHS, in consultation with medical professional associations and other stakeholders, (1) to establish an educational initiative to encourage health care professionals to seek support and care for their mental health or substance use concerns, and to help such professionals identify and learn how best to respond to risk factors associated with suicide and mental health conditions, with the goal of preventing suicide, mental health conditions, and substance use disorders (SUD), and (2) to address stigma associated with seeking mental health and SUD services.
The Act further requires HHS to award grants to health care entities or medical professional associations to establish programs to promote mental health for health care professionals. Priority will be given to eligible entities in health professional shortage areas or rural areas. The Act also allows HHS to award “training grants” to support the training of health care students, residents, or professionals in strategies to address mental health and SUD and improve mental health and resiliency.
In addition to looking at the prevalence of mental health conditions among health professionals, and the barriers to seeking and accessing mental health care, HHS is required to submit a report to Congress that reviews the impact of the COVID-19 public health emergency on the mental health of health care professionals and lessons learned for future public health emergencies. This report will also disseminate best practices to prevent suicide and improve mental health and resiliency for health care providers. Lastly, the Act requires the Government Accountability Office to report on the extent to which relevant federal grant programs address the prevalence and severity of mental health conditions and substance use disorders among health care providers.