• NSA I-Tact

  05.13.24 I-Tact Meeting Notes

  Posted by name on May 14, 2024 at 9:05 am

  Quick Recap:
  The team discussed various issues including the lobby day, a data report on lobby activities, and feedback on recent events like the solution summit and an educational program panel. They reviewed the implications of a recent cyber-attack and changes related to healthcare policies and regulations. Additionally, they discussed ongoing audits, the enforcement of rules by government departments, and the results of a study on out-of-network claims and their impact on healthcare rates. Finally, they talked about legislative work being carried out by Congress and issues with the new resubmission process.

  Action Items:
  

  1. Patrick will finalize the drafting language for the NSA enforcement legislation, ensuring it is ready for introduction during EDPMA Lobby Day.
  2. Bob will clarify and resolve the misinterpretation regarding the cooling period for claim submissions, ensuring accurate implementation of the QPA.

  Antitrust Policy, Lobby Day, and Summit Feedback:
  Ed informed the team about the Antitrust policy and the upcoming Lobby Day. He also introduced a new data report related to lobby activities and requested feedback on the recent Solutions Summit and the FHPC and I-TACT portions of their approach. Randy invited suggestions for improvements in the next summit. The team also discussed the recent Federal Health Policy Committee’s educational program panel presentations, highlighting their informative nature but expressing confusion about the committee’s role. They agreed on the need for clearer nomenclature to avoid misunderstandings in future meetings.

  April Attack, Health Policy, and Flexibility:
  Ed, Randy, and Patrick discussed the April 2nd cyber-attack and its implications for grace periods, as well as the Federal Health Policy and NSA implications of changes in healthcare. Randy mentioned an ongoing pathway for codification or regulation to clarify the definition of initial payment and shared that Patrick’s strategy of requesting extensions for claims processed during a certain timeframe was approved by CMS. Finally, Patrick indicated that a bipartisan letter from the Ways and Means Committee to CMS, requesting similar flexibility, was under review and expected to be issued soon, with Kathryn working on turning it into an EDPMA product.

  Audit Delays and QPAs Discussion:
  Ed discussed the delay in the first audit results, expected in the first half of 2024, and the ongoing 23 audits. He also highlighted the departments’ decision to push back the deadline for determining QPAs to November 1st, while noting that they were still working on their audits. Ed suggested that a letter could be sent to the authorities requesting they instruct the Ides not to use the QPAs as the formula has been ruled invalid by the Federal court. Randy and Tony confirmed that such a letter was in process, along with developing stock language for IDR submissions and drafting another letter to the agencies seeking clarification on the QPA. Randy also mentioned that Brenna’s panel discussion had prompted further action.

  Tri Departments’ Enforcement and Formula Issues:
  Randy, Ed, and Kathryn discussed the issue of tri departments’ enforcement discretion and the necessity of a valid formula. They decided to wait for the TMA III appeal ruling from the 5th circuit to determine their next steps, while also considering socializing the problem with other departments. The team further deliberated on the scope of the issue, their winning percentage in certain situations, and the potential financial harm caused by a decrease in in-network payments. Lastly, they discussed the need for a clear ruling in the appeal, with concerns raised about two items not being appealed by the government, leading to a discussion on the accountability of the administration and potential legal action.

  IDR Determinations, and Report:
  There was a discussion regarding when Secretary Becerra was asked about plans not paying IDR determinations. Becerra acknowledged this as a problem but mentioned he might need more authority from Congress. Patrick noted that his response was positive for their current endeavors. Randy shared that the findings would be ready by Lobby Day and would be distributed to both Lobby Day attendees and those who were not.

  Out-of-Network Claims Study and Issues:
  Randy presented the results of a study on 648,000 out-of-network claims, indicating a decrease in initial payments for all auto network claims. However, a significant backlog remained with 92% of claims waiting for an IDR determination. Randy also highlighted that 17% of the time, health plans changed patients’ cost sharing, which was an absolute never event. He emphasized the need for an easy-to-understand solution due to the impact of out-of-network and in-network pressures on healthcare rates. Ed pointed out the issue of physician groups and hospitals filing numerous claims, which was a view shared by Patrick. Patrick questioned the source of the data supporting the claim amount decrease, asking whether it was derived from actual claims or a survey question.

  QPA Collection and Legislative Updates:
  

  Ed asked Randy about the QPA collection for the years 2022 and 2023, to which Randy confirmed he had combined the figures. Ed then encouraged the work group chairs to meet before the Summit. Patrick later discussed legislative work being carried out by Congressman Murphy and the NSA, aiming to have it ready for the EDPMA Lobby Day. They were optimistic about adding a Democrat to the original co-sponsors before introduction. A potential for a bipartisan introduction of a report was also discussed, with Senator Bennett expected to take the lead, and Senator Cassidy as the Republican lead. Patrick was positive about the progress.

  Final Rule Release and Resubmission Issues:

  Tom’s group discussed taking action to push for the release of a final rule that is awaited. Stephanie raised issues with the new resubmission process, including a perpetual loop and incorrect claim assignments, which EDPMA Lobby Day was assigned to address. Ed acknowledged Bob’s concern about misinterpreting the cooling period for filing claims with CCIIO. The team agreed to reschedule the next full committee meeting to 3 pm on May 28th to avoid Memorial Day. The conversation ended productively with thanks from Ed and Randy.

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