As Texas Representative Beth Van Duyne (R) prepared to enter the Ways and Means Committee hearing, she took time to share questions from “medical professionals” and “service providers” for HHS Secretary Becerra.
Van Duyne's line of questioning was focused not only on Becerra but on the failed implementation of the No Surprises Act.
“Mr. Morris, Congress wrote the Information Act very intentional and with specific guidance. Yet we have continued to see the administration ignore congressional intent during the implementation. Secretary Becerra is going to be in front of this committee on Wednesday in Ways and Means. If you were in my seat, what questions would you ask him?” said Rep. Van Duyne.
“Probably, the top of the list would be how are you monitoring and foreseeing how qualified payment amounts are determined? Because what we’re seeing on our end, and what’re being used by commercial insurance as qualified payments amounts, we based on our own actuarial data and fair health data, which is a repository of benchmarks, of payments,” said Morris in response to Van Duyne's questioning.
He continued, “It appears there’s a lot of opportunity there for enforcement on working with payers to make sure that they’re honoring the way that statute was intended in the way those QPAs are being calculated is appropriate. That would be at the top of my list.”
Roth, on the other hand, focused on the patients’ needs.
“I think at this point, I would ask the question about how we address medical necessity. And the main reason that our patients activate our healthcare systems, activate the service. How do we sit down and resolve those based on discussing that patient encounter, the patient’s needs and the reason they entered the system?” said Roth.
Zawadzki concluded the questions by challenging the processes in the medical system.
“I think I would ask him what is the right thing for the patient and, in this particular case, certainly regard to the IDR, it is a flawed process. CMS has even sort of hinted that they acknowledge it’s a flawed process because it started and stopped and suspended it back on again,” said Zawadzki.
“So, having a close review of the process, making sure that the provider and the payer are on equal footing, which was the original intent. That is clearly not happening as we’re hearing from all the providers here, many of whom are safety net providers, that can’t afford to play the games that are currently being played with the IDR process,” concluded Zawadzki.
