Key Health Plan Transparency Requirements Delayed

As discussed in our prior blog post, the No Surprises Act requires non-grandfathered group health plans offering coverage to disclose information regarding in-and out-of-network rates for certain covered items and services and prescription drugs in machine-readable files on a publicly available website. The machine-readable file requirements apply to plan years beginning on or after January 1, 2022.

Not long after the No Surprises Act was passed, Congress enacted the Consolidated Appropriations Act (“CAA”).  The CAA addressed several of the same types of disclosures but also applied to grandfathered plans.  Due to this overlap, the IRS/DOL/HHS issued additional guidance in the form of FAQs. In the FAQs, the Departments confirmed they will enforce the machine-readable file provisions but enforcement will be delayed.

First, enforcement of the requirement to publish files regarding prescription drug pricing is deferred pending further rulemaking. Second, enforcement of the requirement to publish the files regarding in-network rates and with out-of-network allowed amounts and billed charges is delayed until July 1, 2022.

Specifically, with regard to the July 1, 2022 delay for the network pricing, the three agencies announced they will enforce the requirement for plan years beginning on or after January 1, 2022.  With this in mind, plan sponsors should plan to post machine readable files regarding network pricing in the month in which the plan year begins.

The No Surprises Act also required plans to make price comparison information available to participants through an internet-based tool and in paper form, upon request, for plan years beginning on or after January 1, 2023, with respect to a list of 500 items and services, and for all covered items and services, for plan beginning on or after January 1, 2024.  However, the CAA, added its own requirement for price comparison but required the guidance also be available by telephone. This provision was supposed to apply to plan years beginning on or after January 1, 2022.

In the new FAQs, the three agencies, recognizing the CAA requirements duplicate the prior guidance, announced they will align the compliance deadlines to be effective for plan years beginning on or after January 1, 2023.  The agencies further announced that they intend to propose a new rule that requires the comparison information to be available via website, paper, or via telephone, if requested.

Many of the requirements of the No Surprises Act and CAA were not addressed by the FAQ and therefore do not have an extension. These include the requirement to include deductibles and out-of-pocket costs on ID cards, continuity of care, and the prohibition on entering into contracts with gag orders.  The FAQS did state that further guidance will be forthcoming and that, until the guidance is issued, plan sponsors should comply by implementing reasonable, good faith interpretations of these requirements.

The delay in some of the requirements is good news for plan sponsors and insurers alike.  However, the delay does not push the deadline back much so plan sponsors, especially self-insured plan sponsors, should begin discussing the requirements and the ability to comply with their TPAs and ASOs now.  If you have any questions about these new requirements or benefits in general, please contact any of Graydon’s employee benefits team.