The Consolidated Appropriations Act, 2021 (“CAA” or the “Act”) includes several transparency requirements for health plans. Some of these requirements are already in effect for plan years beginning on or after January 1, 2022. This alert outlines the plan requirements and their respective enforcement deadlines for compliance, as well as intersecting requirements of the Transparency in Coverage Final Rules of November 2020 (TiC Final Rules).
Current Enforcement
The requirements identified in this alert are expected to be subject to additional rulemaking. In the interim, the Department of Health & Human Services (HHS) guidelines provide that plans should implement these requirements using a “good faith, reasonable interpretation of the law.”
Requirements effective for plan years beginning on or after January 1, 2022.
Deferred Enforcement – Specified Alternate Enforcement or Effective Dates
Enforcement of the requirements below has been deferred to a later date. Respective enforcement deadlines are identified in each description.
Deferred Enforcement – Pending Additional Rulemaking
Enforcement of the following requirements has been deferred until additional regulations are issued.
For more information regarding the CAA transparency requirements and how they may apply to your health plan, please contact the authors.
Requirement |
Original Applicability |
Enforcement |
Notes |
Health Provider Directories |
Plan years beginning on or after January 1, 2022 |
January 1, 2022 – based on a “good faith, reasonable interpretation” of the statute. |
Future rulemaking anticipated. |
Plain Language Disclosures on Balance Billing Restrictions |
Plan years beginning on or after January 1, 2022 |
January 1, 2022 – based on a “good faith, reasonable interpretation” of the statute. |
Future rulemaking anticipated.
|
Cost-sharing Disclosures on Identification Cards |
Plan years beginning on or after January 1, 2022 |
January 1, 2022 – based on a “good faith, reasonable interpretation” of the statute. |
Future rulemaking anticipated.
|
Continuity of Care Rules |
Plan years beginning on or after January 1, 2022 |
January 1, 2022 – based on a “good faith, reasonable interpretation” of the statute. |
|
Machine-Readable Disclosure Rules: In-Network and Out-of-Network |
Plan years beginning on or after January 1, 2022 |
Deferred to July 1, 2022 |
|
Pharmacy Benefit and Prescription Drug Cost Reporting |
2020 Data Reporting Deadline – December 27, 2021
2021 Data Reporting Deadline – June 1, 2022 |
Deferred to December 27, 2022 for 2020 and 2021 data (anticipated).
June 1 for each year thereafter. |
|
Price Comparison Tool |
Plan years beginning on or after January 1, 2022 |
Deferred to plan years beginning on or after January 1, 2023 |
|
Advanced EOBs |
Plan years beginning on or after January 1, 2022 |
Deferred - TBD |
Enforcement is deferred until the Departments adopt final rules on the good faith estimate provisions for Providers. |
Machine-Readable Disclosure Rules – Prescription Drug Pricing |
Plan years beginning on or after January 1, 2022 |
Deferred - TBD |
Enforcement is deferred pending further rulemaking. |