• NSA I-Tact

  03.04.24 I-TACT Meeting Notes

  Posted by name on March 5, 2024 at 9:13 am

  Quick Recap:

  The team discussed the discontinuation of fireflies due to security and privacy concerns, emphasizing the use of the Zoom summary function as a replacement. They also talked about the potential need to extend a deadline and the impact of a system disruption on their operations. The topic of extending filing deadlines due to an ongoing outage was also discussed, with the team agreeing to consider the conditions under which an extension would be acceptable. The team also deliberated on the challenges in defining the date of initial payment in their payment process and the potential need for a grace period. The conversation shifted to the decreasing out-of-network benefits in insurance contracts and its potential implications.

  Summary:

  Discontinuation of Fireflies and EMpowered Priorities
  Ed and Cathey discussed the meeting agenda and the change letter. Jeff had to leave for picking up his wife at the airport. Aron joined the meeting, and the team discussed the discontinuation of fireflies due to security and privacy concerns, with the Zoom summary function being a replacement. Ed emphasized that EMpowered would be the one source of truth and reminded the team about the antitrust policy. Towards the end of the meeting, Ed mentioned that he would rely on Randy and Kathryn for updates.

  Cost Sharing, Cybersecurity, Relief Efforts, and Survey Updates
  Ed, Cathey, Randy, and others discussed a recent letter addressing changing cost sharing amounts and the potential impact of a healthcare cyber-attack. Randy praised the letter and its specific solutions, while Ed confirmed only a few other organizations had addressed MIPS and emergency use exemptions. There were concerns about relief efforts for hospitals and other providers facing financial strains, with Randy suggesting that if hospitals receive relief funds, they should be earmarked for emergency medicine or other affected areas. Patrick raised questions about the terms and conditions of a provider loan program offered by UHC, and the team also discussed ongoing efforts to monitor the situation and advocate for relief. Lastly, Greg shared an update on the survey, mentioning he had received two data sets and was expecting more responses.

  Deadline, Lobby Day, Cost Sharing, System Disruption
  The team discussed the potential need to extend a deadline, with Greg and Cathey planning to make a decision by the end of the week. They also discussed an upcoming Lobby Day and an initial analysis that will be conducted following the deadline. The team addressed the issue of plans changing the cost sharing after IDR determinations, with Patrick pointing out a disconnect due to a cyber-attack. The team considered reaching out to CMS to address this issue. The discussion concluded with a review of the change issue, with Jennifer proposing a solution to extend the reconciliation period for payments. The team also discussed the impact of a system disruption on their operations, with Jennifer suggesting requesting an extension from CMS. The team agreed that the grace period should mirror the system downtime.

  Outage Impacts Deadlines and Data
  The team deliberated on the potential need for an extension on filing deadlines due to an ongoing outage. Ed proposed suspending all deadlines during the outage period, while Jennifer suggested a survey to determine the needed length of the extension. Randy suggested proactively informing others about the issue. The team agreed to consider the conditions under which an extension would be acceptable, rather than setting a specific timeframe. They also discussed the impact of a change on their business, with concerns raised by Patrick about data obsolescence. Jennifer suggested having informal discussions to keep the issue on everyone’s radar. The urgency of the situation was a recurring theme in the conversation.

  Outage Impacts and Relief Strategies
  The team discussed the significant outage and its impact, emphasizing the need for accommodation without administrative burdens. Randy suggested informing Bob about the effects on EDPMA members, such as cash flow disruptions and sufficiency assessments, and the risk of timely filing. Ed agreed, highlighting the potential deluge of information that will need to be reconciled once the system is back up. The team also discussed the need to manage expectations and anticipated asking for relief but did not specify the form this relief would take. Shanna was busy converting the CMS IDR report into a word document for editing and commenting, with the team discussing the implications of the NSA clock starting with the date of the payment and the relief related to the IDR filing periods and time requirements.

  Payment Process Challenges and Solutions
  There was a discussion about the challenges in defining the date of initial payment in their payment process. Randy proposed a solution to consider the payment complete only once both the money and the files were received. Ed and Patrick raised concerns about remembering when the payment was received and the potential influx of remits on the days it goes live. It was suggested that a grace period might be needed. Randy, Patrick, and Ed discussed the current situation and potential solutions, agreeing that having no backlog and all necessary resources would help mitigate the situation. Randy suggested asking for additional time to work through the issues, referencing previous instances where they were granted more time. Ed brought up an upcoming deadline on March 14th, indicating some urgency to the situation.

  Grace Period, AHIP Report, and Budget Deal Discussion
  Ed initiated a conversation about the March 14th grace period, asking if there were any concerns related to it. Shanna, Stephanie, and Randy agreed that all claims should have been adjudicated by then, suggesting no issues with the grace period. Ed then assigned Randy and Kathryn to follow up with Heart Health and report back to the group. The conversation shifted to the AHIP report and the possibility of Mr. Becerra going before Congress. Patrick suggested drafting some questions for this eventuality. The team also discussed a partial budget deal and its potential impact. Towards the end, Ed asked if there were any other new business items, but no new topics were raised.

  Insurance Contracts: Decreasing Out-of-Network Benefits
  Jennifer expressed concerns about the decreasing out-of-network benefits in insurance contracts, suggesting that insurance companies may be shifting costs to patients. The team discussed the potential implications of this issue, including it being viewed negatively and potentially causing PR problems. The discussion concluded without a clear resolution or next step, leaving the issue open for further exploration. The team suggested reaching out to the plan benefits for more information, finding a patient with the same insurance in 2023 and 2024 to compare benefits, and checking their own benefits to see if there were any changes.

  EPO Plans and NSF Legislation Discussion
  There was a discussion about the increasing confusion surrounding EPO plans and whether they are used as workarounds for the NSA. Patrick noted an increase in EPO plan patients and speculated on the plans’ possible circumvention of the NSA. Aron suggested that the state where the plan is licensed should have registration information. Patrick also mentioned ongoing collaboration with Congressman Murphy’s office and a proposed legislation related to the National Science Foundation (NSF) aiming to address payer noncompliance in the enforcement of IDR awards. The legislation, not yet introduced, would impose penalties for late or non-payments of IDR awards. The team is working on getting bipartisan original co-sponsors from each of the three committees of jurisdiction in the house.

  Next Steps:

  1. Randy will investigate and provide specific examples of what can be done by the departments.
  2. EDPMA will post the letters sent on Friday on Empowered.
  3. Randy will work on a quote and response from EDPMA.
  4. Randy will reach out to trusted parties to discuss the potential impact of the Change outage on IDR processes and the need for relief.
  5. Randy and Cathey will follow up with Heart Health and inform the group with the results. Cathey will also address the EDMA notice in the chat during the call with Bob.
  6. Patrick will send Jeffrey a note to discuss the legislation with him.

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