Departments Delay Enforcement of Transparency Disclosure Requirements | Fisher phillips


Group health plan sponsors will soon be faced with formidable new disclosure and transparency requirements under several laws, including the Affordable Care Act (ACA), the No Surprises Act (the Act). and the Consolidated Appropriations Act, 2021 (CAA). The different rules overlap and may conflict in some areas. As a result, the U.S. Departments of Health and Human Services, Labor, and the Treasury recently published FAQ guidelines specifically to help plan sponsors understand their obligations under the Final Rules of Transparency in Coverage (Final Rules TiC) published under the ACA and similar provisions of the CAA. The FAQ also extends the time frames (as shown in italics below) within which plan sponsors must comply with the rules.


Under TiC’s final rules, non-grandfather group health plans must disclose on a public website information about the rates of on-grid and off-grid providers, the amounts allowed and fees charged, negotiated rates and prices. prescription drug history covered. These rules will require plan sponsors to develop three separate, machine-readable publishable files for plan years beginning on or after January 1, 2022. Departments released final TiC rules before Congress passed the CAA and, unfortunately, the drafters of the CAA did not fully reconcile the new requirements (which also apply to grandfather plans) with those already set by the ACA.

Prescription drug prices

Departments understand that the CAA contains transparency rules regarding the reporting of prescription drugs by plan sponsors. Since both sets of rules could lead to duplication and waste, departments will delay the application of the final TiC rule on the publication of machine-readable files regarding the prices of prescription drugs until they publish. additional final rules. Thus, non-grandfathered plan sponsors will not have to publish this information by January 1, 2022.

The CAA also requires plan sponsors to submit information about prescription drug spending to ministries that includes:

  • the dates of the year of the general scheme;
  • information on the registration census; and
  • specific details of the 50 most frequently dispensed drugs, the 50 most expensive drugs and the 50 drugs whose spending increased the most year over year.

Plans must also report average monthly premiums, prescription drug spending, and the impact of any prescription drug manufacturer rebates on spending. The ministries have stated that they will provide the final regulations to come and that they will not enforce these provisions before that date. However, ministries are encouraging plans to prepare to report 2020 and 2021 information by December 27, 2022.

Network details

Again citing the potential overlap and conflict between TiC’s final rules and CAA’s transparency provisions, departments announced that they would not enforce TiC’s final rule requiring public disclosure of network tariffs and amounts authorized outside the network before July 1. , 2022. Thus, non-grandfathered plan sponsors will have an additional six months to prepare compliant documents in order to fulfill this mandate. New plans that start after July 1, 2022 must post appropriate machine-readable files in the month in which the plan year begins.

Price comparison tool

TiC’s final rules require that non-grandfathered plans adopt and publish (via an internet portal or, upon request, in writing) a price comparison tool to allow participants to purchase the prices of 500 items and services identified by departments for plan years starting on or after January 1, 2023. Plan sponsors should extend the tool to cover items and services for plan years starting on or after January 1, 2024. Not surprisingly, the CAA requires Also that non-grandfathered and grandfathered plans provide price comparison advice from plan years. effective January 1, 2022 – one year earlier than under TiC’s final rules. Departments will not apply price comparison rules under the final CAA or TiC rules until plan years beginning on or after January 1, 2023.

Insurance cards

The CAA requires plans and insurers to improve health plan identification cards by including maximum information on deductibles and disbursements. Additionally, for plan years beginning on or after January 1, 2022, ID cards will need to show a phone number and website address for individuals to obtain further information. Departments intend to provide future guidance on the disclosure of identity cards. Until then, plans and issuers should make reasonable efforts to comply.

For example, reasonable efforts might include disclosing the primary medical deductible and maximum reimbursable information, as well as a phone number and website address for further information on the deductible and maximum reimbursable amount. The ministries also say the plans could make additional information available via a QR code (if hard copy) or hyperlink (if electronic).

Explanation of the advantages

On or after January 1, 2022, CAA requires providers to provide individuals with good faith estimates of the costs of services and any items to be provided when planning services or requesting an estimate. The CAA further requires that plans provide a prior explanation of benefits based on good faith estimates from service providers. Departments will not apply the plan sponsor provisions until they release final future rules.

Precise information on the supplier directory

The CAA requires plans to provide accurate supplier directories and update them regularly to keep them accurate. CAA further requires that plans respond to requests from participants and beneficiaries regarding the state of the provider network. If a person receives services from an off-network provider or facility but received incorrect information in a provider directory that the provider or facility was on-network, the plan should limit the charges to network levels. . Departments intend to issue final rules regarding this requirement, but will not do so until January 1, 2022. Departments expect plans to make good faith efforts to comply until publication. final rules. In the meantime. departments will not penalize plan sponsors who limit cost-sharing amounts to maximum levels in the network for non-network services or items received by a covered person who received incorrect information about the status of the network in the network. a directory of suppliers.


The FAQ offers welcome relief (and more time) to plans facing deadlines to comply with new binding disclosure and reporting obligations. Plan sponsors should ensure they understand these requirements and take reasonable steps to comply in good faith until departments provide further guidance.

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