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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations
individuals within the following timeframes:
A When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling;
B When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished: Not later than 3
business days after the date of scheduling; or C When a good faith estimate is requested by an uninsured or self-pay individual: Not later than 3 business days after the date of the request.
vii A convening provider or convening facility must provide an uninsured or self-pay individual who has scheduled an item or service with a new good faith estimate if a convening provider, convening facility, coprovider, or co-facility anticipates or is notified of any changes to the scope of a good faith estimate such as anticipated changes to the expected charges, items, services, frequency, recurrences, duration, providers, or facilities previously furnished at the time of scheduling; a new good faith estimate must be issued to the uninsured or self-pay individual no later than 1 business day before the items or services are scheduled to be furnished.
viii If any changes in expected providers or facilities represented in a good faith estimate occur less than 1
business day before the item or service is scheduled to be furnished, the replacement provider or facility must accept as its good faith estimate of expected charges the good faith estimate for the relevant items or services included in the good faith estimate for the items or services being furnished that was provided by the replaced provider or facility.
ix For good faith estimates provided upon request of an uninsured or selfpay individual, upon scheduling of the requested item or service, the convening provider or convening facility must provide the uninsured or self-pay individual with a new good faith estimate for the scheduled item or service within the timeframes specified in paragraphs b1viA and B of this section; and x A convening provider or convening facility may issue a single good faith estimate for recurring primary items or services if the following requirements are met, in addition to the requirements under this section:

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A The good faith estimate for recurring items or services must include, in a clear and understandable manner, the expected scope of the recurring primary items or services such as timeframes, frequency, and total number of recurring items or services; and B The scope of a good faith estimate for recurring primary items or services must not exceed 12 months. If additional recurrences of furnishing such items or services are expected beyond 12 months or as specified under paragraph bvii of this section, a convening provider or convening facility must provide an uninsured or self-pay individual with a new good faith estimate, and communicate such changes such as timeframes, frequency, and total number of recurring items or services upon delivery of the new good faith estimate to help patients understand what has changed between the initial good faith estimate and the new good faith estimate.
2 Requirements for co-providers and co-facilities. i Co-providers and cofacilities must submit good faith estimate information as specified in paragraph c2 of this section upon the request of the convening provider or convening facility. The co-provider or co-facility must provide, and the convening provider or convening facility must receive, the good faith estimate information no later than 1
business day after the co-provider or cofacility receives the request from the convening provider or convening facility.
ii Co-providers and co-facilities must notify and provide new good faith estimate information to a convening provider or convening facility if the coprovider or co-facility anticipates any changes to the scope of good faith estimate information previously submitted to a convening provider or convening facility such as anticipated changes to the expected charges, items, services, frequency, recurrences, duration, providers, or facilities.
iii If any changes in the expected coproviders or co-facilities represented in a good faith estimate occur less than 1
business day before that the item or service is scheduled to be furnished, the replacement co-provider or co-facility must accept as its good faith estimate of expected charges the good faith estimate for the relevant items or services included in the good faith estimate for the item or service being furnished that was provided by the replaced provider or facility.
iv In the event that an uninsured or self-pay individual separately schedules or requests a good faith
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estimate from a provider or facility that would otherwise be a co-provider or cofacility, that provider or facility is considered a convening provider or convening facility for such item or service and must meet all requirements in paragraphs b1 and c1 of this section for issuing a good faith estimate to an uninsured or self-pay individual.
c Content requirements of a good faith estimate issued to an uninsured or self-pay individual. 1 A good faith estimate issued to an uninsured or selfpay individual must include:
i Patient name and date of birth;
ii Description of the primary item or service in clear and understandable language and if applicable, the date the primary item or service is scheduled;
iii Itemized list of items or services, grouped by each provider or facility, reasonably expected to be furnished for the primary item or service, and items or services reasonably expected to be furnished in conjunction with the primary item or service, for that period of care including:
A Items or services reasonably expected to be furnished by the convening provider or convening facility for the period of care; and B Items or services reasonably expected to be furnished by coproviders or co-facilities as specified in paragraphs b2 and c2 of this section;
iv Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service;
v Name, National Provider Identifier, and Tax Identification Number of each provider or facility represented in the good faith estimate, and the States and office or facility locations where the items or services are expected to be furnished by such provider or facility;
vi List of items or services that the convening provider or convening facility anticipates will require separate scheduling and that are expected to occur before or following the expected period of care for the primary item or service. The good faith estimate must include a disclaimer directly above this list that includes the following information: Separate good faith estimates will be issued to an uninsured or self-pay individual upon scheduling or upon request of the listed items or services; notification that for items or services included in this list, information such as diagnosis codes, service codes, expected charges and provider or facility identifiers do not need to be included as that information will be provided in separate good faith estimates upon scheduling or upon
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