A number of new transparency-related rules impose new obligations upon employers that sponsor group health plans to their employees. GBS is committed to support you in your efforts to comply as new information becomes available and as new requirements go into effect.
If you have any questions, or are looking for additional information, please reach out to your GBS Broker or Consultant.
GBS has a multi-phase approach to assist you as you navigate, prepare, and comply with the collection of new transparency requirements found in the Transparency in Coverage final rules (TiCFR) and the Consolidated Appropriations Act (CAA).
Phase I: Education
GBS has been tracking the development of these regulations and released summaries as new rules were published. We expect to see additional detailed guidance on some of these provisions and when that happens we will continue to update and add materials and educational resources as we learn more. There are several separate and different transparency rules, each with various effective dates and requirements. As a result, it is easy to confuse one rule for another and not understand what is required. This confusion is exacerbated by the fact that some requirements are somewhat similar, and the fact that “transparency rule” is commonly referenced within most of them. To help you keep these rules straight and to help provide a high-level overview and education, we created a matrix. This matrix, the in-depth summaries on individual provisions, and future educational materials on the new transparency rules can be found at gbsbenefits.com. In addition, a chronological timeline is provided at the end of this documents. We encourage you to review that timeline as well as the materials at this link to become familiar with what will impact your plan.
Phase II: Outreach
GBS is currently communicating with carriers, TPAs, PBMs and provider network partners to identify how each of these service providers plan to assist groups with each separate requirement. The level of support from these providers will vary depending on the rule and whether the plan is fully insured or self-funded. To date, many providers are still trying to determine exactly what they can and cannot provide. The early trend suggests groups with insured plans will have many of the obligations significantly supported by the carrier and self-funded plans may need to contract with their TPA, PBM, or other third-party entity to complete some of the requirements.
Phase III: Planning
Once your specific carrier, TPA, PBM, or provider network releases information specific to the application of transparency requirements to your group health plan, you can start planning the specific actions and steps you will need to take. GBS will help communicate your options and help you to understand if there are any additional costs or any vendors who may need to be engaged. It is important to remember in this phase that even if a carrier, TPA or other service provider assists you with transparency rules obligations, responsibility for compliance falls upon the group health plan.
Phase IV: Execution
Put your compliance plan into action according to the compliance effective dates and requirements for each requirement within each provision. This phase may include amending contracts and/or engaging with vendors to provide additional support. There is a learning curve here for all parties, which is typical with new rules and requirements, so flexibility and adjustments may be necessary as additional clarifications through regulations are issued and as we learn more. As this progresses, GBS will help coordinate with providers and guide you through the execution of your plan.
Effective Dates
In the above-mentioned Matrix Overview, the transparency rules are listed and organized by topic to assist with the education, outreach and planning phases. Please see pages 4-9 to review the Matrix Overview. To assist with the planning and the execution phases, we also included the requirements by date, starting with the earliest effective date. Please review the those dates below, listed in chronological order, as they stand today. For more information refer to the Matrix Overview, the in-depth summaries, or contact your GBS team. Please see next page for a reference list of effective dates
December 27, 2020
- CAA Transparency in Coverage – Removal of Gag Clauses from contracts with service providers
February 10, 2021
- CAA Mental Health Parity and Equity Act (MHPAEA) reports – This is the date the Departments were authorized to begin requesting reports from group health plan. Note they began making these requests
December 27, 2021
- CAA Transparency in Coverage – Disclosure of Broker Compensation
January 1, 2022
- CAA No Surprises Act – the following requirements are effective for plan years starting on this date:
– Balance billing disclosures,
– Participant ID cards,
– Up-to-date provider directories,
– Public posting for participants about federal and state surprise bill protections (on website and in each explanation of benefits), and
– Continuity of Care when there is a change in network
Starting 2022 (no specific 2022 date yet)
- CAA Transparency in Coverage – Group health plans must submit annual attestations that no Gag Clauses exist in any contracts with service providers
July 1, 2022
- TiCFR Public Disclosure – Files 1 and 2, which are the files that must contain the applicable rates with in-network providers and covered services for out-of-network providers (changed from original effective date of 1/1/22)
December 27, 2022
- CAA Transparency in Coverage – Reporting to the Departments on Pharmacy Benefits and Drug Costs (changed from original effective date of 1/27/21). This is a “soft” effective date mentioned by the Departments and will be confirmed in future regulations. Note that the first report will include both 2020 and 2021 data
January 1, 2023
- TiCFR Private Disclosure – disclosure to participants, first 500 items and services listed •
- CAA No Surprises Act – Price cost-sharing comparison tool for participants by phone and website (original effective date was 1/1/22)
January 1, 2024
- TiCFR Private Disclosure – disclosure to participants, remaining items and services listed, in addition to the first 500
Delayed Effective Date until Guidance is Issued:
- CAA No Surprises Act – Advanced Explanation of Benefits and Good Faith Estimates (original effective date was 1/1/22)
Deferred Enforcement:
- TiCFR Public Disclosure – File 3 (file for prescription and drug data) will be reconsidered in future rulemaking. It is possible these will be deferred indefinitely to avoid duplication with CAA and so only the reporting under the CAA pharmacy and drug costs reporting will be required and enforced (original effective date was 1/1/22).
