Update: No Surprises Act – What Clinical Social Workers Need to Know About New Federal Regulations

As many of you know, the new federal rule to protect consumers from surprise health care bills went into effect on January 1, 2022. This rule includes LCSW's. We are working with our national team to provide more guidance and information on this rule change, however wanted to highlight for you a few things you should know:

Several federal agencies including the US Department of Health and Human Services and the Department of Labor have issued new regulations implementing the No Surprises Act. These went into effect on January 1, 2022 and have implications for clinical social workers (CSWs) and many other health provider types as well as healthcare facilities, insurers and health plans. The No Surprises Act was enacted by Congress in late 2020 and is intended to prevent consumers from receiving unanticipated medical bills.

The new regulations have three parts, two of which are most relevant to the business and billing practices of CSWs. Part I applies to CSWs who are out of network providers at in network facilities, and requirements preventing balance billing of patients when they are provided CSW services in this scenario. Part II applies to broadly all CSWs who are licensed, certified or approved by the state and provide services to patients who are uninsured or wish to self-pay (e.g., are insured but do not intend to file a claim). Part II requires that these providers furnish good faith estimates (GFEs) to current/future patients of these types.

The new regulations outline the specific information that GFEs must include, the timeframes for furnishing them to current/future patients (prior to services being rendered), and the dispute resolution process if a patient wishes to contest a bill because it is substantially higher (defined as $400 or more) than what was outlined in the GFE they received. NASW is awaiting clarification from HHS regarding some of the rule provisions, and will update members as we receive that information. NASW is also continuing to advocate on behalf of members with key federal regulators. Many provider groups are also seeking clarification from regulators on these rules, several parts of which were implemented quickly at the end of 2021. For more information, please review the following posts in the Social Work Blog:

Update: Federal Rule to Prevent Surprise Health Care Billing - Jan 5, 2022

Federal Rule To Prevent Surprise Health Care Billing - Dec 21, 2021

NASW has created a customized template that social workers may use as a model for their GFE, which can be found here: Model Good Faith Estimate

Here is a link to CMS's Model Notice to Patients

Here is a link to resources including templates from the Centers for Medicare & Medicaid Services (CMS) that can be used to prepare good faith estimates and model language for informing patients of their rights to a GFE.