NSA I-Tact
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ITACT Result: CMS Response to EDPMA September Recommendations for NSA Implementa
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ITACT Result: CMS Response to EDPMA September Recommendations for NSA Implementa
EDPMA received a CMS response to our September letter sent to the Departments regarding ongoing implementation issues with the No Surprises Act. I’ve attached it here (along with a copy of your letter that generated the response). Since there are a lot of communications moving, as a reminder, your September letter was an EDPMA-only letter (no ACEP) that originated out of I-Tact recommendations. It focused on the unique circumstances of emergency care, QPA miscalculations, requests for clarity on IDR eligibility, general recommendations to reduce dependence on IDR, and enforcement (including on post-IDR payment determination health plan non-payment).
The CMS response is attached- while I’m sure everyone has continued concerns about actual enforcement, there do not appear to be any instances where they say “we don’t have the authority for that” or “we don’t understand your concern.” In that regard, it’s a good reply. As part of the CMS response on incorrect QPA calculations, this is some good language that you’ll be able to refer back to as needed as well:
The Departments have established a process for providers to submit complaints regarding plan and issuer non-compliance with the NSA’s QPA disclosure requirements and other NSA requirements. We strongly encourage providers who do not receive the required QPA disclosures at the time of initial payment or denial of payment to submit a complaint to the No Surprises Help Desk (NSHD). In general, after the NSHD receives a complaint, the complaint is reviewed in its entirety and is sent to the agency with the appropriate enforcement jurisdiction for further review. If the state has enforcement authority, the NSHD provides the appropriate contact information for that state so that the state may assist the provider with their specific situation. The Centers for Medicare & Medicaid Services (CMS) is actively investigating and addressing complaints under its jurisdiction, and if a violation is found, CMS will not hesitate to enforce the requirement for the applicable entity to make the required QPA disclosures. In appropriate circumstances, violations may trigger civil money penalties.
There are several references to the complaint portal and audits as the appropriate vehicle for resolution of many of these issues, and as we know, we still have yet to see any evidence that those mechanisms will address your concerns. But nonetheless, it was not a reply dismissing concerns and this response isn’t a form letter so hopefully there was some retention of your concerns.
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