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Federal Register / Vol. 86, No. 192 / Thursday, October 7, 2021 / Rules and Regulations request of such items or services; and include instructions for how an uninsured or self-pay individual can obtain good faith estimates for such items or services;
viii A disclaimer that informs the uninsured or self-pay individual that there may be additional items or services the convening provider or convening facility recommends as part of the course of care that must be scheduled or requested separately and are not reflected in the good faith estimate;
ix A disclaimer that informs the uninsured or self-pay individual that the information provided in the good faith estimate is only an estimate regarding items or services reasonably expected to be furnished at the time the good faith estimate is issued to the uninsured or self-pay individual and that actual items, services, or charges may differ from the good faith estimate;
and x A disclaimer that informs the uninsured or self-pay individual of the uninsured or self-pay individuals right to initiate the patient-provider dispute resolution process if the actual billed charges are substantially in excess of the expected charges included in the good faith estimate, as specified in 149.620; this disclaimer must include instructions for where an uninsured or self-pay individual can find information about how to initiate the patient-provider dispute resolution process and state that the initiation of the patient-provider dispute resolution process will not adversely affect the quality of health care services furnished to an uninsured or self-pay individual by a provider or facility; and xi A disclaimer that the good faith estimate is not a contract and does not require the uninsured or self-pay individual to obtain the items or services from any of the providers or facilities identified in the good faith estimate.
2 Reserved d Content Requirements for Good Faith Estimate Information Submitted by Co-Providers or Co-Facilities to Convening Providers or Convening Facilities. 1 Good faith estimate information submitted to convening providers or convening facilities by coproviders or co-facilities for inclusion in the good faith estimate described in paragraph c1 of this section must include:
i Patient name and date of birth;
ii Itemized list of items or services expected to be provided by the coprovider or co-facility that are reasonably expected to be furnished in
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conjunction with the primary item or service as part of the period of care;
iii Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service;
iv Name, National Provider Identifiers, and Tax Identification Numbers of the co-provider or cofacility, and the States and office or facility locations where the items or services are expected to be furnished by the co-provider or co-facility; and v A disclaimer that the good faith estimate is not a contract and does not require the uninsured or self-pay individual to obtain the items or services from any of the co-providers or co-facilities identified in the good faith estimate.
2 Reserved e Required Methods for Providing Good Faith Estimates for Uninsured or Self-Pay Individuals. 1 A good faith estimate must be provided in written form either on paper or electronically, pursuant to the uninsured or self-pay individuals requested method of delivery, and within the timeframes described in paragraph b of this section. Good faith estimates provided electronically must be provided in a manner that the uninsured or self-pay individual can both save and print. A
good faith estimate must be provided and written using clear and understandable language and in a manner calculated to be understood by the average uninsured or self-pay individual.
2 To the extent that an uninsured or self-pay individual requests a good faith estimate in a method other than paper or electronically for example, by phone or orally in person, the convening provider may orally inform the uninsured or self-pay individual of information contained in the good faith estimate using the method requested by the uninsured or self-pay individual;
however, in order for a convening provider or convening facility to meet the requirements of this section, the convening provider or convening facility must issue the good faith estimate to the uninsured or self-pay individual in written form as specified in paragraph e1 of this section.
f Additional compliance provisions.
1 A good faith estimate issued to uninsured or self-pay individual under this section is considered part of the patients medical record and must be maintained in the same manner as a patients medical record. Convening providers and convening facilities must provide a copy of any previously issued good faith estimate furnished within the last 6 years to an uninsured or self-pay
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individual upon the request of the uninsured or self-pay individual.
2 Providers or facilities that issue good faith estimates issued under State processes that do not meet the requirements set forth in this section fail to comply with the requirements of this section.
3 A provider or facility will not fail to comply with this section solely because, despite acting in good faith and with reasonable due diligence, the provider or facility makes an error or omission in a good faith estimate required under this section, provided that the provider or facility corrects the information as soon as practicable. If items or services are furnished before an error in a good faith estimate is addressed, the provider or facility may be subject to patient-provider dispute resolution if the actual billed charges are substantially in excess of the good faith estimate as described in 149.620.
4 To the extent compliance with this section requires a provider or facility to obtain information from any other entity or individual, the provider or facility will not fail to comply with this section if it relied in good faith on the information from the other entity, unless the provider or facility knows, or reasonably should have known, that the information is incomplete or inaccurate.
If the provider or facility learns that the information is incomplete or inaccurate, the provider or facility must provide corrected information to the uninsured or self-pay individual as soon as practicable. If items or services are furnished before an error in a good faith estimate is addressed, the provider or facility may be subject to patientprovider dispute resolution if the actual billed charges are substantially in excess of the good faith estimate as described in 149.620.
g Applicability1 Applicability date. The requirements of this section are applicable for good faith estimates requested on or after January 1, 2022 or for good faith estimates required to be provided in connection with items or services scheduled on or after January 1, 2022.
2 Applicability with other laws.
Nothing in this section alters or otherwise affects a providers or facilitys requirement to comply with other applicable State or Federal laws, including those governing the accessibility, privacy, or security of information required to be disclosed under this section, or those governing the ability of properly authorized representatives to access uninsured or self-pay individuals information held by providers or facilities, except to the
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