December 07, 2021
The Business Group appreciates the thoughtful and balanced approach taken by the DOL/EBSA, Treasury/IRS, and HHS (the ""Departments"") to improve clarity and certainty for individuals receiving care, promote early and efficient payment resolution between payers and providers, and reduce the need for expensive and time-consuming independent dispute resolution (IDR). We generally agree with the Departments’ overarching approach to implementing the CAA, but have provided targeted comments on material matters we believe need further review, clarification, emphasis, or modification.
Our comments focus on three areas:
- 1 | supporting the primacy of the qualifying payment amount (QPA) as the assumed appropriate payment amount in an IDR proceeding;
- 2 | ensuring that any IDR effort is justified by an appropriate ""material difference"" in the dollar amounts at issue so as to avoid small, wasteful disputes and the abuse of IDR for the purpose of foisting expenses on plans;
- 3 | advocating for a compliance assistance (versus monetary penalties) enforcement using a "good faith" standard during implementation.