Agencies Issue FAQs on Upcoming Transparency Requirements

On August 20, 2021 the Departments of Labor (DOL) and Health and Human Services (HHS) and the Treasury (the Departments) issued frequently asked questions (FAQs) regarding the implementation of various transparency provisions of the Affordable Care Act (ACA) and the Consolidated Appropriations Act (CAA).

Deferred Enforcement of Some Requirements

The Departments will defer enforcement of the rules, regarding:

• Publishing machine-readable files relating to prescription drug pricing (pending further rulemaking);
• Publishing machine-readable files disclosing in-network rates, out-of-network allowed amounts and billed charges (until July 1, 2022);
• Providing a price comparison tool (until January 1, 2023);
• Providing a good faith estimate of expected charges and advanced explanation of benefits to certain individuals (pending further rulemaking); and
• Reporting of prescription drug and other benefits and costs (pending further rulemaking).

Future Guidance

The Departments plan to issue regulations on the interaction of the price comparison tool required by both the ACA and the CAA, as well as requirements related to provider directories, identification cards, continuity of care and balance billing disclosure. Regulations may not be issued until after January 1, 2022. Until then, plans and issuers are expected to use good faith, reasonable interpretations of the statute.

The FAQs also included an example of what could be considered good faith compliance as it relates to identification cards, including the ability to include a link or QR code for the member to get additional information not printed on the identification card.

The Departments indicated they do not expect to issue regulations on provisions prohibiting gag clauses yet will issue future implementation guidance to explain how plans should submit their attestations of compliance. The Departments anticipate beginning to collect these attestations starting in 2022.

More Information

Reach out to your Hylant representative for further information. Don’t have one? Contact us here.

The above information does not constitute advice. Always contact your employee benefits broker or trusted adviser for insurance-related questions.