Reporting deadlines for several new group health plans are approaching – See our CAA/Price Transparency Checklist | Bulletins | Legal News: Insights into employee benefits

This year, Foley’s Health Benefits Practice has issued multiple alerts on several of the new group health plan requirements set forth by the Consolidated Appropriations Act of 2021 (CAA) and the Transparency in Coverage (TiC) provisions under the Affordable Care Act (ACA) . To review all of the essential CAA and TiC requirements, you can access our Plan Sponsor Checklist here and our Plan Service Provider Checklist here. This article summarizes the new CAA and TiC reporting requirements with deadlines soon approaching.

Prescription Drug Data Collection (RxDC) for 2020 and 2021 data – December 27, 2022. As summarized in our previous articles here (plan sponsor perspective) and here (plan service provider perspective), RxDC reports for calendar years 2020 and 2021 are due in a few days (December 27, 2022). Regulators – specifically the Centers for Medicare & Medicaid Services (CMS) – have provided numerous instructions, templates, and other materials to help reporting entities complete this RxDC reporting. The CMS reporting instructions provide a step-by-step overview of the required data files. CMS also recently issued several FAQs about problems reporting entities experience with data files, including when an employer-provided health plan uses multiple providers (eg, two third-party administrators). Reporting entities must already have their accounts set up on the Health Insurance Portability Oversight System (HIOS) portal and must be ready to finalize the RxDC data files for submission. CMS has informally indicated that the HIOS portal will remain open until January 31, 2023 to accept data files from 2020 and 2021, but regulators have yet to issue any formal extension or exemption from non-implementation beyond December 27, 2022

Self-Service Price Comparison Tool – 1 January 2023. As summarized in our article here, the CAA and TiC regulations require group health plans to provide certain disclosures to plan members upon request, including in the form of a self-service price comparison tool. At a high level, the rules require a group health plan to create an online self-service tool that allows plan members to search for specific services covered by the plan with specific health care providers, and the tool must provide advance service, real-time information such as for example, whether the provider is in-network or out-of-network under the plan, whether cost-sharing (eg, copayment, coinsurance, or deductible) applies to this service, the member’s current deductible and out-of-pocket maximums accrued, and whether prior authorization is required for the service . By January 1, 2023, the tool must address 500 commonly covered services, and then must address all included services by January 1, 2024.

Air Ambulance Cost Reporting – 31 March 2023. As summarized in our article here, the CAA requires group health plans to report specific air ambulance claim data. The requirements are currently set out in a proposed rule (as discussed in our previous article). The proposed rule provides that group health plans must submit their air ambulance claims reports for calendar year 2022 by March 31, 2023. Given that the requirements are currently only in proposed form and we have received little guidance from regulators on how this reporting will be possible if this reporting deadline is extended or the rule is changed in its final form. However, we currently understand that this deadline is still in effect and the reporting requirements must be met as set forth in the proposed rule.

RxDC reporting for 2022 data – June 1, 2023. RxDC reporting (summarized above) for calendar year 2022 is due on June 1, 2023, so there is not a large gap between reporting for calendar years 2020 and 2021 and calendar year 2022.

The Foley Health Benefits Practice advises employers, health plans, insurance carriers, third party administrators, pharmacy benefit managers, point solution companies and other health plan service providers on these requirements. Our team is happy to help as companies work on these requirements for the first time.

As part of Foley’s ongoing commitment to providing legal information to our clients and colleagues, our Employee Benefits and Executive Compensation Group has a monthly newsletter we call Employee Benefits Insights, where we bring you up-to-date information on the most new and pressing issues affecting employee benefits and other related topics. Click here or click the button to the left to subscribe.

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