Benefits Brief: Consolidated Appropriations Act
On October 29, 2020, the Departments of Labor, Health and Human Services, and the Treasury (collectively,
“the Departments”) finalized proposed rules regarding transparency requirements for non-grandfathered group health plans. The Transparency in Coverage (“TiC”) rules initially required disclosures of pricing and cost-sharing under plans to first take effect beginning January 1, 2022. On August 20, 2021, the Departments issued an FAQ that delayed the TiC requirement to publish certain machine-readable files (“MRFs”) on a public website.
Briefly, the TiC rules require public disclosure, via MRFs, of the following information:
- In-network provider rates for covered medical items and services; and
- Out-of-network allowed amounts and billed medical charges for covered items and services.
A third required MRF disclosing negotiated rates and historical net prices for covered prescription drugs is currently delayed pending future guidance.
Employers should be prepared to comply with the MRF disclosure requirements, as follows:
- For plan years that begin between January 1, 2022, and July 1, 2022, the files must be posted by July 1,
- For plan years that begin after July 1, 2022, the information must be posted in the month the plan year
- Going forward, the information must be updated monthly and clearly indicate the date the files were most recently updated.
Who is Responsible for Compliance?
Employers can rely on the carrier to post this information when there is an agreement between the plan and the carrier. If the carrier fails to provide full or timely information, the carrier (not the plan/employer) is liable.
What is the Disclosure Requirement?
MRFs will typically contain vast amounts of data such that they will be quite large. They will be in a machine-readable language such that the data will not be easy to interpret or search, and few, if any, plan sponsors will be able to meet the disclosure requirements on their own. Thus, carriers and TPAs are assisting plan sponsors in complying with these requirements by hosting the files and posting them on public servers or websites they will maintain.
This disclosure requirement is unique in that it must be made to the public as opposed to most disclosure requirements that are limited to plan participants. As such, posting the information or a link to the information on a company’s intranet or behind a password protected page will not be sufficient disclosure.
Employers may post a link to the MRFs from the carrier on their public website. Coordinate with IT resources to ensure that a link to the MRFs is posted timely.
Carrier Specific Action
Below is a listing of common carriers utilized by BSI clients. Carriers that have provided a link have confirmed that this link is active but they have not posted their files to date. They will post them by July 1st so you can publicly post the link on your website to comply with the law.
- Capital Blue Cross – https://www.capbluecross.com/wps/portal/cap/about/machine-readable-file-transparency-in-coverage
- Highmark – Has not yet provided a link to the machine readable files
- Geisinger – https://www.geisinger.org/health-plan/nosurprisesact
- Amerihealth – https://www.ahatpa.com/transparency-in-coverage/67890?key=xxxxxxx
- UnitedHealthcare – https://transparency-in-coverage.uhc.com/?_gl=1*1iz4w5n*_ga*NTMxMzU0OTExLjE2NjE1MTg1ODI.*_ga_HZQWR2GYM4*MTY2MTUxODU4Mi4xLjAuMTY2MTUxODU4Mi4wLjAuMA
- Aetna – https://health1.aetna.com/app/public/#/one/insurerCode=AETNACVS_I&brandCode=ALICSI/machine-readable-transparency-in-coverage?reportingEntityType=Third%20Party%20Administrator_6644&lock=true
As other links become available from each carrier, BSI will make them available to all clients.
BSI is planning on following up with further resources for future compliance regulations regarding the CAA TiC rules. These
items will include:
- Advanced Explanation of Benefits – 1/1/2023 due date
- Online Pricing Tools – 1/1/2023 due date
- Compensation Disclosures
In addition, we will be hosting a webinar on a future date to provide expert guidance on all upcoming compliance measures regarding the CAA regulations.