NSA Update

NSA Update 

The gears for the IDR process are almost frozen. A multitude of operational problems persist that almost too numerous to mention. Non-transparency of QPA calculations, egregiously low insurer payments, insurer refusal to negotiate, difficulties in determining eligible claims, barriers to batching, arbitrator backlogs, and IDRE excessive fees are just a few of the problems that have made the IDR process nearly impossible to navigate for providers.  The chance of the Departments willingly issuing regulatory relief is slim to non-existent.

Health insurers are taking advantage of the situation by cancelling contracts and refusing to negotiate new contracts.

The Texas Medical Association has filed two new lawsuits challenging the Departments guidance on factors for the arbitrator to consider and the lack of transparency by insurers in determining the QPA. Congressional oversight of the botched implementation of the NSA has been non-existent but may change under Republican control of the House.