• NSA I-Tact

  01.10.24 Standing I-Tact Meeting Notes

  Posted by name on January 10, 2024 at 6:07 pm

  AI meeting summary:

  • Ed Gaines mentions that a product out of Rand is expected to be released by June, but there is uncertainty about the timeline. Ed also asks if anyone else has been interviewed by Rand regarding the challenges in implementing the NSA. He notes that Rand does not have the right to publish the data they gather through their interviews. Ed mentions upcoming discussions with Rand and other members of EDPMA on specific topics. He emphasizes the need for fair payment for care providers and expresses hope for improvements after the final rule comes out. Ed also highlights concerns about delays in implementing an improved system and potential circuit court rulings on TMA appeals. There are comments from others regarding plans using abusive tactics, as well as negative feedback received from Families USA and Consumer Reports. The group discusses maintaining pressure and momentum while considering future initiatives that bring ROI for emergency medicine, such as prompt pay requirements or changes to Medicare coverage. They express concern about potentially losing momentum without a clear focus on what to address next. The group suggests leveraging relationships and past successes while exploring new avenues for advocacy efforts, possibly including FHPC meetings or aiming for ERISA inclusion of prompt pay requirements.
  • Ed Gaines expresses concerns about the situation where health plans are shifting liability onto patients after initially adjudicating claims. He discusses the potential violation of NSA protections and questions whether regulators are more focused on billing patients than addressing health plan violations. Tom Sugarman suggests taking a creative approach to telling this story, as data may not be convincing enough for departments. Ed Gaines also raises issues with incorrect adjudication of claims and difficulty in processing complaints with CMS due to jurisdictional challenges. The need for patient interviews to support media coverage is highlighted. The transcript ends with discussions on lobbying efforts and gathering data on complaint issues to counter inaccurate reports from agencies like GAO.
  • Concerns are raised about about batches that have been stuck for over a year and wonders if there are rules allowing this. She also questions if anyone has received notifications of objections delaying the process. Ed Gaines discusses the importance of understanding policymakers’ motivations to engage them effectively. He suggests presenting issues related to enforcement report errors but acknowledges it may not be enough to get their attention. Ed emphasizes the need to consider different approaches based on the audiences, including Republicans focused on staying in office and HHS officials aiming not to hinder Joe Biden’s reelection. The conversation shifts towards conducting a new survey, called Maroon report 2.5, with updated data elements related to complaints and claims filed within 30 days but remaining unpaid or incorrect after payment. They plan to finalize the survey by January 22nd and discuss posting it on ITACT empowered for feedback from members.
  • Ed Gaines suggests moving a work group meeting to 3:00 p.m. on Mondays, starting on January 22nd and continuing every two weeks thereafter. Cathey B Wise agrees to set up the meetings and cancel them if necessary.

  Action items:

  Ed Gaines:

  1. Gather data on the number of complaints filed and the discrepancy between the numbers reported by the tri-agencies and the actual numbers.

  2. Explore the possibility of including patient involvement in the data collection.

  3. Consider sending a survey to EDPMA members to collect updated data on key elements related to the NSA.

  4. Update the Maroon report with the new data collected through the survey.

  Tom Sugarman:

  1. Help frame the questions for the survey on complaints and provide input on the elements that should be included.

  name replied 1 year, 2 months ago 1 Member · 0 Replies
• 0 Replies

Log In to Reply