HHS FAQs on IDR recertification and cooling off period report

On July 10, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) released the Federal IDR Entity Recertification FAQs to address the recertification of IDR entities. An organization must provide written documentation that demonstrates the entity meets certain standards to be certified as an IDR entity for a five-year period to conduct arbitration in the IDR process. Organizations that intend to continue operating as IDR entities will need to complete recertification before the end of their five-year certification period.

The Departments also recently released an interim report on the NSA IDR “cooling off period.” As part of the IDR process, a 90-day cooling off period is initiated after an IDR award is determined to encourage parties to use that amount to settle similar disputes through open negotiations rather than the IDR process. In the interim report, the Departments acknowledge that the cooling off period is not working as intended. The report highlights concerns raised by providers and hospitals (e.g., delayed payment, underpayments, lack of access to IDR) and issuers and health plan associations (e.g., inconsistent enforcement of cooling off period, and new disputes submitted to IDR before the 90-day period expired).

The Departments do not propose any concrete actions other than continuing to collect data from parties about their experiences and monitoring. Cigna is working with industry and coalition partners to build support for regulatory and legislative action to address the misaligned incentives and escalating abuse in the IDR process contributing to rising health care costs.