July 1 Deadline for Health Plan Price Transparency Requirements
In August 2021, the Departments of Health and Human Services, Labor, and Treasury jointly released guidance delaying several health plan price transparency disclosure requirements of the Transparency in Coverage Rule and the No Surprises Act. Several of the updated deadlines take effect July 1, 2022.
To stay compliant, find out more about these requirements.
What is the Transparency in Coverage Rule?
The Transparency in Coverage Rule is federal regulation issued by the Departments of Health and Human Services (HHS), Labor (DOL), and Treasury in November 2020.
The rule implements a section of the Affordable Care Act (ACA), requiring insurers and group health plans to:
- offer an online price comparison tool for beneficiaries that includes personalized information about cost-sharing covered services and items, including prescriptions.
- provide publicly available machine-readable files that include detailed information on in-network negotiated rates and historical data for out-of-network charges for covered services and items, including prescriptions.
What is the No Surprises Act?
The No Surprises Act is a part of the Consolidated Appropriations Act (CAA), a COVID-related stimulus package that became law in December 2020. The law was designed to restrict out-of-network healthcare charges that “surprise” individuals with unexpected bills.
Most provisions of the No Surprises Act don’t directly impact employer-sponsored healthcare coverage, but there are a few rules that small to midsize businesses must comply with, especially regarding health plan price transparency. The law requires group health plans to:
- provide an “advanced” explanation of benefits, including good-faith estimates of out-of-pocket expenses for specific scheduled medical services.
- report prescription drug cost information in detail, including the 50 most expensive and the 50 most commonly covered drugs per plan.
What Are the Health Plan Price Transparency Disclosure Deadlines?
In August 2021, HHS, DOL, and Treasury released Frequently Asked Questions about the impending health plan price transparency disclosures. Most notably, the guidance delayed several requirements of the Transparency in Coverage Rule and the No Surprises Act:
- The online price comparison tool requirement—originally set to take effect on January 1, 2022—has been delayed till January 1, 2023.
- Similarly, the machine-readable files requirement—also initially set to take effect on January 1, 2022—has been delayed. Regulation stipulates three publicly available files disclosing information about:
- in-network rates (delayed till July 1, 2022)
- out-of-network allowable amounts (delayed till July 1, 2022)
- prescription drug costs (delayed till further regulation is made available)
- Enforcement of the “advanced” explanation of benefits provision under the No Surprises Act—which was supposed to go into effect on January 1, 2022—has been deferred till further regulation is made available.
- In November 2021, the agencies released further guidance for the prescription drug cost reporting requirement. Enforcement for 2020 and 2021 plan-year reporting has been deferred till December 27, 2022. Originally, initial reports were to be provided to HHS, DOL, and Treasury by December 27, 2021, and by June 1 of each year, starting in 2022.
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