News Archive

"It appears that this CAA transparency requirement, like others under the CAA, would not apply to retiree-only plans. For health reimbursement arrangements (HRAs) -- including individual coverage HRAs -- and other account-based plans, the Departments ... are using discretion when it comes to enforcing this requirement until they can exempt these plans through the official rulemaking process."  MORE >>

"Pay close attention to who has the responsibility to comply with Mental Health Parity disclosures (and other disclosure requirements) related to the CAA.... It is time to get serious (and maybe even more serious) about privacy and security.... Employers who have employees located in California in particular should be looking at these rules to ensure that their benefit plan service providers are in compliance with these requirements."  MORE >>

34 presentation slides. Topics include: [1] Washington update; [2] Consolidated Appropriations Act of 2021 (CAA): prescription drug reporting, surprise billing, MHPAEA analysis on Non-Quantitative Treatment Limitations (NQTLs), miscellaneous CAA items; [3] Transparency in coverage reporting; [4] Dobbs v. Jackson Women"s Health Organization and medical travel benefits; [5] Recap of coronavirus impact on employer H&W benefits; [6] Proposed 1557 regulations; and [7] COLA updates.  MORE >>

"Although [this article identifies] many action items ... employers will focus their 2023 compliance efforts in three areas: [1] how the Supreme Court's Dobbs v. Jackson Women's Health Organization decision impacts their health plans' coverage of abortion services; [2] how the end of the COVID-19 emergency declarations, when announced, will impact their health plans' coverage of COVID-19 and related services; and [3] how to comply with the requirements under the Consolidated Appropriations Act, 2021, including, but not limited to, the prohibitions against surprise billing under the No Surprises Act, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) comparative analysis, broker and consultant compensation disclosures under Section 408(b)(2) of [ERISA], and the medical and drug cost reports that are initially due December 27, 2022, and every June 1 thereafter."

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"[T]he Consolidated Appropriations Act of 2021 ... extended through 2025 the ability to treat reimbursements of student loans as tax-free under IRC Section 127. Creating or expanding an [educational assistance plan] may be an attractive way to recruit and retain dedicated employees, particularly during difficult labor market conditions."  MORE >>

"The Consolidated Appropriations Act, 2021 adopted a series of transparency requirements that apply to employer-sponsored group health plans.... A subset of these transparency requirements, while not likely well suited to class action claims, will nonetheless prove vexing.... [P]rovisions relating to mental health parity seem perfectly designed to attract class actions claims.... The motherlode for the plaintiffs' bar however is in the broker/consultant compensation disclosure rules."

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11 pages; 47 Q&As covering [1] Independent Dispute Resolution (IDR) entity qualifications and the application process (16 Q&As); [2] Fees (10 Q&As); and [3] The Federal IDR process (21 Q&As).

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"Health plans and insurers must regularly verify the information in their provider directories and promptly update that information ... In the event an enrollee is misled by a provider directory and mistakenly receives care from an out-of-network provider, the enrollee's liability will be limited to an in-network cost-sharing amount, with that amount applied to the in-network deductible and out-of-pocket maximum."  MORE >>

54 pages. "None of the comparative analyses EBSA or CMS have initially reviewed to date contained sufficient information upon initial receipt. EBSA has issued 80 insufficiency letters addressing over 170 NQTLs, identifying specific deficiencies in the comparative analyses and requesting additional information to remediate those deficiencies.... EBSA has issued 30 initial determination letters, finding 48 NQTLs imposed on MH/SUD benefits violated MHPAEA's parity requirements.... [This Report] also describes the lack of sufficient comparative analyses for plans and issuers and provides some examples of how the CAA's provisions have allowed the Departments to supplement existing MHPAEA enforcement programs, resulting in participants and beneficiaries gaining increased access to MH/SUD benefits."  MORE >>

"The main controversy over surprise billing legislation was never over the surprise bills themselves. Rather, the controversy was over determining how much insurers should pay for out-of-network care once patients are held harmless.... [It] is likely that the ban on surprise billing will in fact tilt the scale of market power away from physicians and hospitals and toward the payers of health care."  MORE >>

"The No Surprises Rules also introduce a negotiation and dispute resolution process for situations where the health plan and provider do not agree that the plan's ordinary payment is appropriate. The rules set a strong presumption as to the amount ... The rules ... [include] information that plans will need to provide to participants about the expected costs and benefits for a service subject to the rules. This requirement is delayed, pending further guidance."  MORE >>

"This post addresses the narrow question of the reporting of general agent commissions under the new rules and in light of Field Assistance Bulletin 2021-03. The question is of practical interest, and it also sheds light on the [DOL's] initial approach to the interpretation of the statute."

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"[The Interim Final Rules require] Reporting Entities ... to report annually information about prescription drug and health care spending.... [The] rules apply broadly to grandfathered plans, church plans, non-federal government plans, and individual coverage through or outside of an exchange.... The data the plans and insurance issuers must submit ranges from general plan identifying information and the states in which the plans operate to more precise information."  MORE >>

"While the Provision imposes a series of procedural requirements, it is compliance with the substance of Provision that is currently top of mind ... what must be disclosed, exactly, when, and what form must the disclosure take? ... Under a plain reading of the statute, contracts governing 2022 renewals of group health plans with calendar year plan years would appear exempt from the new rules.... [A]bsent some relief, renewals of contracts governing plans with non-calendar plan years commencing in 2022 will need to comply."

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"The sole item on IRS's 2021 Required Amendments (RA) List (Notice 2021-64) relates to restoring suspended benefits for multiemployer plans receiving special financial assistance (SFA) under [ARPA].... Notably absent ... is any extension of the statutory deadline for amendments relating to the [SECURE Act], the Bipartisan American Miners (Miners) Act, and the [CARES Act]. The deadline for those amendments remains the end of the 2022 plan year."  MORE >>

"The No Surprises Act requires plan sponsors to comply with some of the most burdensome tasks since the ACA.... With most provisions taking effect on January 1, 2022, the timeline for compliance is tight ... Carriers and plan administrators could potentially raise their prices to pay for the extra work required to manage and implement the new processes. Additionally, this legislation can increase costs for self-funded plans by making plan sponsors responsible for amounts not covered by participant cost sharing."

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"2021 has been another challenging year for employers. ARPA and CAA legislation have created additional compliance responsibilities for employers. As the calendar year comes to an end here are some things to remember."

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"[S]everal provisions [of the Consolidated Appropriations Act of 2021 and related regulations, and the Transparency in Coverage Rule] that will have a large impact on self-funded health plans are effective in January 2022, including requirements related to surprise billing. [This checklist is designed] to help employers with self-funded health plans be aware of the obligations imposed by these laws and the steps they may need to take to comply[.]"  MORE >>

"Since the new rule requires covered plans and insurers to report data for prescription expenditures in 2020 and 2021 by December 27, 2022 and annually thereafter, covered plans and insurers will want complete the necessary arrangements to collect the data as soon as possible to minimize the cost and burdens of collecting and preparing the reports required at the end of the year."

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"The [Interim Final Regs], which would take effect in January 2022, effectively leaves patients out of the fight. Providers and insurers have to work it out among themselves, following the new policy ... [M]any doctors, their medical associations and members of Congress are crying foul, arguing the rule ... favors insurers and doesn't follow the spirit of the legislation.... The controversy pertains to a section of the [interim] final regulations focusing on arbitration."  MORE >>

"A key requirement of the [Consolidated Appropriations Act (CAA)] going into effect on December 27, 2021 will require brokers and consultants of ERISA covered group health plans to disclose their compensation if they expect to receive $1,000 or more in either direct or indirect compensation for providing their services."

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"The COVID-19 pandemic and the federal government's response have transformed the 2020 and 2021 employee benefits landscape. These changes will extend into 2022, depending on how long the COVID-19 public health emergency lasts.... The CAA includes numerous provisions that impact employer-sponsored group health plans, including the much-anticipated rules regarding surprise medical bills.... Prepare for compliance with Transparency in Coverage rules ... Comply with large employer shared responsibility rules or face penalties[.]"  MORE >>

"The DOL, state insurance regulators, state attorneys general, and private parties have an array of tools to probe a plan's compliance with MHPAEA. ERISA's disclosure obligations require health plans to provide their comparative analysis demonstrating MHPAEA compliance ... The CAA further broadened disclosure and access requirements for plan beneficiaries ... And the price transparency rules will give yet another tool for providers, beneficiaries, and regulators to evaluate reimbursement rates for potential parity compliance."

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"Removal of gag clauses ... Broker and consultant compensation disclosure ... Medical and drug cost reporting ... Mental health parity and addiction equity act (MHPAEA) comparative analysis ... Surprise billing ... Surprise air ambulance bills ... Reporting requirements regarding air ambulance services ... Modify identification cards ... No discrimination against certain providers ... Advanced explanation of benefits (EOB) ... Continuity of care ... Price comparison tool ... Provider directory and coverage information requests."

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"As rulemaking finalizes, HHS can use three unique No Surprises Act provisions to build durable affordability standards through the mandated arbitration process ... HHS should also carefully monitor the IDR turnaround time and characteristics of arbitration requests to make sure payers and providers do not manipulate or inadvertently overwhelm the system ... The long-term risk to these 'compromise' solutions embedded in the No Surprises Act is that average people could pay more out of pocket in the form of premiums."  MORE >>