The Federal No Surprises Act (“the Act”) will go into effect for healthcare providers and health plans beginning January 1, 2022. With an eye toward protecting patients from unexpected out-of-network medical costs, this law will require payers and providers to interact and negotiate in new ways. Health care providers and health care facilities should begin preparations now for implementing the requirements of the Act.
In addition to protecting insured patients from out-of-network costs, the No Surprises Act implements protections for uninsured or self-pay patients. Effective January 1, 2022, healthcare providers and facilities will be required to provide a good faith estimate of charges to a patient for any service that is scheduled at least three days in advance. Where the service will involve multiple healthcare providers, the scheduling provider is required to coordinate with the other providers to gather information necessary to timely provide this estimate, although enforcement of this coordination is delayed until December 31, 2022. The estimate may include disclaimers and explanations of potential unknown factors that may impact the cost.
Many healthcare providers received an unanticipated cash infusion on or around April 10, 2020 (“Emergency Fund Payment”). Accompanying the payments was a list of terms and conditions attached to the funds. The U.S. Department of Health and Human Services (HHS) has stated that forms and additional information will be forthcoming; but in the meantime, the only available guidance is a letter to providers and the list of terms and conditions.
One of the most heavily-debated legal and ethical issues to arise during the current COVID-19 outbreak is what methodology a hospital should use to allocate ventilators when the number of patients who need a ventilator exceeds the hospital’s supply of ventilators. Even more heavily discussed is whether a hospital should disconnect a patient from a ventilator against the wishes of the patient and his/her family in order to use that ventilator for another patient with a statistically greater chance of survival.
During times of national or local crisis, people often look to the pillars of their communities, local employers, charities and other publicly-supported institutions, to provide much needed resources and stability. In many rural communities, the local hospital fits into all three categories being one of the largest (if not they largest) local employer, charity and publicly-supported institution in the community (other than the local government). As a result, people often look to hospitals during times of crisis, not just for healthcare services but also for the other resources needed in their lives (e.g., food, housing, financial assistance, etc.).
With the potential of scarce resources resulting from the COVID-19 virus, rural hospitals should consider taking immediate action to establish or reconstitute a hospital ethics committee. Although relatively common in large urban hospitals, in our experience ethics committees are relatively rare in rural hospitals. In rural settings, “typical” ethics issues such as end-of-life decisions are often resolved through informal interactions among patients, families, physicians, and administration. However, the COVID-19 pandemic is likely to (if it has not already) raise not-so-typical issues for hospitals that will require a more structured approach. It is likely that hospitals will face issues never before considered about how to ethically apportion scarce resources such as masks, gowns, respirators, ICU beds, and ventilators.
With the effective date for the Comprehensive Care for Joint Replacement (“CJR”) program now upon us, we wanted to take a moment to highlight key steps that affected hospitals should be pursuing if they wish to realize the benefits of – or at a minimum, avoid potential adverse consequences of – this new payment model.
In the Centers for Medicare & Medicaid Services’ (“CMS”) Reporting and Return of Overpayments Final Rule, published February 11, 2016 (“Final Rule”), CMS has clarified some outstanding questions faced by healthcare providers and suppliers who may have received overpayments from the Medicare program.