• NSA I-Tact

  02.05.24 Standing I-Tact AI Notes

  Posted by name on February 5, 2024 at 4:40 pm

  AI meeting summary:

  • Randy Pilgrim and Cathey provide updates on the NSA steering committee’s work, including comment letters they have submitted regarding proposed rules. They also discuss member alerts and complaint data reports from CMS.
  • Randy Pilgrim raises concerns about the number of resolved complaints and the inclusion of ACA and other complaints in the report. There is a discussion about filing a letter or making a statement regarding this issue. A pending letter is mentioned regarding eligibility determination after an IDR entity’s decision. The duration and lack of resolution in audits conducted by CMS are discussed. The placement of complaint reports within work groups is considered, along with potential strategies for addressing the issue. It is noted that the complaint report can be used as a citation to counter insurance industry claims. Updates on the future report template and survey for 2023 dates are shared, including discussions on data gathering timelines and output plans for lobby day. RSVPs are requested for upcoming events in May, including lobby day at the Westin hotel.
  • Patrick Velliky discusses an issue related to changing plans and patient cost sharing after IDRE determination is made, and proposes creating a framework to identify and prevent these violations. Randy Pilgrim shares feedback from discussions with the Department of Labor about examples where patient cost sharing changed after an adverse IDRE decision, expressing concerns about balance billing and violation of the No Surprises Act. Jennifer Brown notes an increase in patient cost sharing over the past 18 months but lacks evidence regarding changes during IDR process. Greg Hufstetler suggests that insurance percentage of allowable may be diminishing. Tom Sugarman mentions that Workgroup C is waiting for new rules but discusses efforts to address misleading narratives by health plans through a myths and reality document.
  • Tom Sugarman expresses his belief that the survey conducted by AHIP and Blue Cross is purposely misleading and deceptive. He mentions that Work Group C will address this issue with Patrick’s help. Jennifer Brown asks about how the survey was distributed, expressing curiosity about responding in a similar manner. Ed Gaines provides information on where to find the press release and full report of the survey. Patrick Velliky highlights the need to respond quickly in the external communications space and discusses working with other specialty groups for a comprehensive approach. Jeff Bettinger mentions health insurers’ potential strategy to blame NSA for margin erosions, suggesting it should be considered in future approaches. Tom Sugarman emphasizes pointing out AHIP’s misleading interpretations of their survey findings and predicts they may blame lowered profits on NSA in the future. The conversation continues regarding highlighting shortcomings in AHIP’s methodology, coordinating with other groups, promoting surveys, discussing frustrations during grace period, and concerns over non-payment of IDR awards.
  • Patrick Velliky discusses the high rates of late and unpaid payments in IDR awards, suggesting that it would be valuable to gather data on this. He mentions that some of their data has been staggering, with only a 31% rate of on-time payment. Patrick also highlights the importance of looking at the proportion of late payments that are not paid at all. The group plans to finalize and deliver their data to Colin. They discuss the need for legislative strategy and identifying the appropriate audience for their message on non-payment issues. Patrick offers to share deidentified versions of their data, noting different criteria used and staggering statistics. They consider sharing plan-specific information with staff members but keeping it confidential in writing. Randy Pilgrim shares his group’s experience with payment improvements but doubts it is due to changes in IDRe forms. Patrick requests blank or filled-in versions of pre- and post-April 1 forms for further analysis.

  Action items:

  1. Patrick Velliky mentioned that Workgroup A will be working on defining the problem of plans changing the recognized amount or patient cost sharing after an IDRE determination. The goal is to create an example framework for groups to build systems that identify these violations and prevent them from being included in a bill.

  2. Tom Sugarman mentioned that Workgroup C is in a holding pattern, waiting for the next round of rules to be released. In the meantime, they will be working on creating talking points and tools to correct misleading narratives in response to a report from AHIP.

  3. Patrick Velliky mentioned that the data on non-payment and late payment of IDRE awards has resonated with policymakers. He encouraged others to gather data on this issue and consider working with other specialty groups to address it.

  4. Ed Gaines and Patrick Velliky discussed the possibility of using the data on non-payment and late payment of IDRE awards to support legislative efforts. They mentioned the need to finalize the data and determine the legislative strategy.

  5. Ed Gaines raised the issue of frustrations during the grace period and asked if there were any specific issues or concerns. There was no immediate response or discussion on this topic.

  6. Patrick Velliky mentioned that he has data on non-payment and late payment of IDRE awards that he would be willing to share. He also expressed interest in obtaining pre and post versions of the IDRE forms to show any changes made by the plans.

  7. Ed Gaines mentioned the upcoming meeting with a congressional office where the issue of non-payment and late payment of IDRE awards would be discussed. He encouraged others to gather data on this issue and consider sharing it with policymakers.

  8. Ed Gaines mentioned the possibility of using the data to show the variability among plans in terms of payment timing and non-payment. Patrick Velliky expressed interest in obtaining the forms to further support their arguments.

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