On Aug. 20, 2021, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued frequently asked questions (FAQs) regarding the implementation of the No Surprises Act and transparency provisions of the Consolidated Appropriations Act, 2021 (CAA).
Deferred Enforcement of Some Requirements
The Departments will defer enforcement of the rules regarding:
- Publishing transparency in coverage machine-readable files related to prescription drug pricing (pending further rulemaking);
- Publishing other types of machine-readable files (until July 1, 2022);
- Providing a price comparison tool (until Jan. 1, 2023);
- Providing a good faith estimate of expected charges and Advanced Explanation of Benefits to certain individuals (pending further rulemaking); and
- Reporting of pharmacy benefit and drug costs (pending further rulemaking).
Other Guidance
The Departments plan to issue regulations on the interaction of the CAA and the transparency in coverage final rules as well as the provider directory and continuity of care requirements. Regulations may not be issued until after Jan. 1, 2022. Until then, plans and issuers are expected to use good faith, reasonable interpretations of the statute.
They do not expect to issue regulations on provisions prohibiting gag clauses or balance billing disclosure requirements. Plans and issuers are expected to use good faith, reasonable interpretations of the statutory requirements.
The Departments also provided an example of a plan or insurance identification card that would be compliant with the transparency requirements for those cards and clarified that grandfathered health plans are generally subject to the CAA’s requirements.
Important Dates
- Dec. 27, 2020: The CAA was signed into law.
- Aug. 20, 2021: The Departments issued 12 FAQs regarding implementation of certain CAA provisions.
- Jan. 1, 2022: Several CAA provisions are scheduled to take effect
ADDITIONAL INFORMATION
For additional information, please contact your Burnham Benefits Consultant or Burnham Benefits at 949‐833‐2983 or inquiries@burnhambenefits.com.
Burnham Benefits does not engage in the practice of law and this publication should not be construed as the providing of legal advice or a legal opinion of any kind. The consulting advice we provide is intended solely to assist in assessing its compliance with the Patient Protection and Affordable Care Act and other applicable federal and state law requirements, and is based on Burnham Benefit’s interpretation of federal guidance in effect as of the date of this publication. To the best of our knowledge, the information provided herein, and assumptions relied on, are reasonable and accurate as of the date of this publication. Furthermore, to ensure compliance with IRS Circular 230, any tax advice contained in this publication is not intended to be used, and cannot be used, for purposes of (i) avoiding penalties imposed under the United States Internal Revenue Code or (ii) promoting, marketing or recommending to another person any tax-related matter.