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On December 6, 2020, we posted an article titled “RADICAL new transparency rules likely apply to your health plan in one year.” The regulations are a little more than 150 PDF pages long. The following is intended to provide a condensed, but more comprehensive, summary of the requirements described in our December 6, 2020 article.
January 1, 2022 – Three files disclosed
For plan years beginning on or after January 1, 2022
Applies to non-grandfathered health plans
Public disclosure
Out-of-network allowed amounts
Negotiated rates and historical net prices for covered prescription drugs
Must be made available on an internet website
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In late October, the Trump Administration, through the Departments of Health and Human Services (“HHS”), the Treasury, and Labor (“Departments”), issued two different rules one implementing the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) COVID-19 vaccine mandate, and the other implementing the Affordable Care Act’s transparency mandate. These rules were part of a rush of health care regulations pushed out the door in the last few months of the Trump Administration.
On October 28, 2020, the Departments released an
interim final rule with request for comment (“IFC”) that, among other things, amends current regulations regarding coverage of preventive health services to implement the requirement under the CARES Act that group health plans and health insurance issuers provide “rapid coverage” of services and vaccines related to the prevention of COVID-19. The IFC also implements
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With the final rule on price transparency, the devil is in the details – all 556 pages’ worth. Our Employee Benefits & Executive Compensation Group provides a way for you to appreciate the initial implications of the rule without having to digest the whole thing.
Transparency: not re-creating the wheel, just making it spin faster
Cost-sharing and required public disclosure of negotiated rates and allowed amounts
Next steps and implications of the Transparency Rule
On October 29, 2020, the Centers for Medicare and Medicaid Services (CMS) along with the Department of Labor (DOL) and Treasury issued a final rule on price transparency to enable patients to accurately predict health care costs in order to make more fully informed and value-conscious decisions.