ACHP: Extend Transparency, Interoperability Compliance Deadlines

July 07, 2021 - The Alliance of Community Health Plans (ACHP) has asked CMS to reassess surprise billing, cost transparency, and interoperability compliance deadlines and health data exchange policies that are putting a strain on health plans.

In a letter to CMS, ACHP noted that the following requirements are hindering health plans’ abilities to focus on COVID-19 vaccine administration, expand the Affordable Care Act, and establish post-pandemic practices: CMS Interoperability and Patient Access regulation, Transparency in Coverage regulation, and the No Surprises Act of the Consolidated Appropriations Act of 2021.

While ACHP agreed with some aspects of the CMS regulations, the organization stressed the need to reevaluate these deadlines due to the challenges that the COVID-19 pandemic introduced.

ACHP requested that CMS extend the current enforcement discretion for the patient access and provider directory requirements through January 1, 2022. The payer organization also asked CMS to extend the payer-to-payer requirements through July 1, 2022 to give health plans more time to work out post-pandemic changes.

Community health plans’ limited resources and staff have made it difficult to meet requirements, causing them to seek help from IT departments or other vendors. In order for health plans to comply with the regulation, the deadline must be extended, ACHP wrote.

ACHP also requested that CMS provide clarity for a prior authorization rule that the agency put on hold shortly after it was finalized. If CMS chooses to continue with the implementation, then the effective date should coincide with the other upcoming regulatory deadlines.

To round out its suggestions surrounding interoperability, ACHP encouraged CMS to improve protections for personal health information within third-party applications.

This would include updating the Interoperability and Patient Access rule to provide better consumer education, as patient data is usually sent to a third-party application by the patient herself. Such an improvement would lessen health plans’ liabilities, according to ACHP.

ACHP expressed concern about the Transparency in Coverage regulation as well and requested that CMS apply enforcement discretion in order to give health plans more time to implement a successful strategy for consumer cost-sharing. The current deadline is January 1, 2022.

ACHP cited a number of issues with the regulation. The machine-readable files requirements included in the regulation are unhelpful to health plans and consumers, as the data does not translate to third-party applications. The files are also not cost-efficient and require a great deal of administrative work.

“While application developers and health care researchers expect this data to provide high value to consumers, health plans use more sophisticated pricing and cost algorithms to predict consumer cost sharing, making the files an unhelpful source of cost and pricing information,” ACHP explained in the letter.

“Understanding individual benefit packages, contract 4 arrangements, historical claims data and other complex information used to estimate out-of-pocket costs, health plans are better suited to provide direct cost estimates to consumers, rather than rely on third-party applications.”

ACHP’s last requests pertained to the No Surprises Act. This act includes the advance explanation of benefits (AEOB) which is already under the Transparency in Coverage and the Interoperability and Patient Access regulations.

ACHP recommended CMS delay its deadline of January 1, 2022 and work with health plans to accomplish the act’s goals in different ways, such as using scheduled service and provider notifications to prompt the sending of AEOBs. This would also prevent members from receiving an influx of unnecessary correspondence.

Another suggestion ACHP presented was that CMS clarify and rectify the overlapping requirements in all three regulations.

“It is unclear how the ‘price comparison tool’ in the No Surprises Act will provide additional meaningful benefit to consumers beyond the ‘cost estimator tool’ in the Transparency in Coverage regulation,” ACHP wrote in the letter.

“The scope of these two requirements should be refocused to better provide consumers with valuable pricing information and avoid inundating consumers with information that may not be relevant to them or may vary from individual to individual.”

With these recommendations, ACHP urged CMS to lighten the load and provide more time for health plans while they focus on post-pandemic needs.