New requirements to increase health care cost transparency

New requirements to increase health care cost transparency

Authored by Bukaty Companies on October 12, 2022

The Consolidated Appropriations Act (CAA) signed into law on December 27, 2020, and the Transparency in Coverage Act (TiC), adopted November 12, 2020, contain a number of initiatives designed to improve health care cost transparency and patient protections. Below is a calendar of key 2022 and 2023 deadlines affecting sponsors of medical plans.

January 1, 2022                                                                                                                                                                                                                                                                          The No Surprises Act put protections in place to eliminate surprise medical billing related to emergency health care services and certain ancillary services provided by
out-of-network providers in an in-network facility. This law prohibits members from being balanced bill by out-of-network service providers for the above-mentioned services.

Starting with January renewals, benefit brokers must disclose to ERISA plan sponsors all direct and indirect compensation received valued at $250 or more. Bukaty
Companies issues the notice as part the renewal process for all ERISA clients and remains committed to ongoing compliance.

July 1, 2022
For plans beginning on or after January 1, 2022, machine-readable files (MRF) containing pricing data for medical items and services were required to be posted on a public-facing website. For fully insured groups, most carriers (insurers) fulfilled the MRF requirement and will be responsible for monthly updates.

December 27, 2022
A new prescription drug reporting mandate requires health insurers and health plans to submit comprehensive pharmacy and medical plan data to the Centers for Medicare and Medicaid Services (CMS) by December 27, 2022. The data request is for calendar years 2020 and 2021. Plan data for 2022 will need to be submitted by June 1, 2023. The data for fully insured plans will be submitted by health insurers. Self-funded groups will need to work with third-party administrators to ensure the required data is submitted to CMS on time. The information will be used by federal departments to prepare a biannual report to Congress on drug costs.

January 2023
Under the TiC final rule, health insurers and health plans must provide a self-service, cost-comparison tool that gives participants personalized out-of-pocket cost information
on 500 specific medical services. Plans must have the tool in place on or after January 1, 2023. The remainder of other medical services must be added to the tool for plans
beginning on or after January 1, 2024. Similar requirements are identified in the CAA, which also requires comparisons by participating providers within a geographic
region. The CAA also requires the cost comparison information be available by phone and website.

Numerous other requirements within the TiC and CAA affecting health insurers and health plans are pending until regulatory agencies provide more guidance. Bukaty
Companies will continue to update clients as more information is made available.

Blog Category: Health Care Reform, Compliance