CAA Changes for 2021 and 2022
2021 | |||||
Effective Date | Covered Plans | Requirement | Details | Action Items | Additional Guidance |
February 10, 2021 | Group Health Plans | Mental Health Parity and Addiction Equity Act comparative analysis | Plans that offer medical and surgical benefits, and medical or substance use disorder benefits and impose nonquantitative treatment limitations on the mental health or substance use disorder benefits must be able to provide a detailed comparative analysis upon request from the DOL, HHS or applicable state agency. | Confirm with TPAs and/or insurance companies that they will comply with these rules. Review plan documents and operations to ensure compliance. | Not later than 18 months after date of enactment, HHS shall finalize any draft or interim guidance and regulations
Tri-departments shall issue compliance program guidance document
Mental Health Parity FAQs Part 25
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December 27, 2021 | Group Health Plans | Broker and consultant compensation disclosure | Brokers and consultants must describe the services they provide and the compensation the receive if they expect to receive direct or indirect compensation in excess of $1,000. A special notice is required for changes to fees or services. | Review current contracts. Contact your broker or consultant to ensure the provide disclosures timely. |
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December 27, 2021 | Group Health Plans or Health Insurance Issuer (except for church plans) | Reporting on Pharmacy Benefits and Drug Cost | Plans must report information on prescription drug spending. In future years, annual reports will be due no later than June 1. | Review TPA contracts so parties understand their responsibilities. Ensure TPA is capable of meeting reporting requirements. | Request for Information Regarding Reporting on Pharmacy Benefits and Prescription Drug Costs |
2022 | |||||
Plan years that begin on or after January 1, 2022 | All group health plans, including grandfathered plans | Surprise billing and independent dispute resolution | Emergency services: plans that cover emergency services must cover emergency services at a nonparticipating provider or facility with in-network cost-sharing or balance billing. Prior authorization is not required.
Non-emergency services: plans must cover non-emergency services of a nonparticipating provider at a participating facility with in-network cost sharing. The cost-sharing must also apply to the participant’s deductible and out-of-pocket maximum. Balance billing is prohibited unless the non-participating provider provides a notice and the participant consents. | If necessary, amend plan documents. If you are self-funded, reexamine your stop loss policy. Confirm that TPAs and insurance carriers will comply with these provisions. Review contracts to include responsibilities for surprise billing, payments, denials, and independent dispute resolution. | Interim Final Rule Requirements Related to Surprise Billing; Part I |
Plan years that begin on or after January 1, 2022 | All group health plans, including grandfathered plans | Surprise Air Ambulance Billing | If the plan covers air ambulance services, it must also cover these services from a nonparticipating provider with in-network cost sharing. The cost-sharing will also apply to the participant’s deductible and out of pocket maximum. Payment or denial must occur with 30 days after receiving a bill for services. The plan and the nonparticipating provider then have 30 days to negotiate the claim. If negotiations fail, the nonparticipating provider may request independent dispute resolution. | If necessary, amend plan documents. If you are self-funded, reexamine your stop loss policy. Confirm that TPAs and insurance carriers will comply with these provisions. Review contracts to include responsibilities for surprise billing, payments, denials, and independent dispute resolution.
| Interim Final Rule Requirements Related to Surprise Billing; Part I |
Plan years that begin on or after January 1, 2022 | Group health plans | Air ambulance service reporting requirements | Plan must provide a detailed report to the DOL, HHS and/or Treasury about its air ambulance claims.
https://www.onedigital.com/blog/hhs-issues-proposed-regulations-for-air-ambulance-services/
| Consult with TPA to confirm compliance and review and revise service agreements, if necessary. | The Departments intend to undertake rulemaking this year to propose the form and manner in which plans issuers, and providers of air ambulance services would report |
Plan years that begin on or after January 1, 2022 | Group health plans | Surprise billing external review | Plans needs to include adverse benefit determinations for surprise bills (medical and air ambulance) in their external review process | Consult with TPA to ensure adverse benefit determinations will be included in the next external review. Update contract language as necessary. | Interim Final Rule Requirements Related to Surprise Billing; Part I |
Plan years that begin on or after January 1, 2022 | Group health plans, including grandfathered plans | Deductible and out-of-pocket limit information on ID cards | Plan ID cards (physical and electronic) must include deductible, out-of-pocket maximum, and contact information for customer assistance. | Confirm TPA and/or carrier will provide compliant ID cards. Update contract language as necessary. | The Departments intend to undertake rulemaking to fully implement this provision but rulemaking might not occur until after January 1, 2022. Until finalized rules are released, plans and issuers are expected to implement using good faith, reasonable interpretation. |
Plan years that begin on or after January 1, 2022 | Group health plans | Prohibitions against provider discrimination | Regarding plan participation or coverage, plan cannot discriminate against any health care provider acting within the scope of their license.
Regulations have not yet been issued, but are required by Jan. 1, 2022. | After regulations are released, review them with counsel, TPAs, and/or health insurance carriers to ensure compliance. |
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Plan years that begin on or after January 1, 2022 | Group health plans, including grandfathered plans | Advanced explanation of benefits | Upon request, plan must provide participants with an advanced explanation of benefits that explains costs for the service and cost-sharing requirements. | Confirm with TPA and/or carrier that they will comply. Review and revise contract language as needed. |
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Plan years that begin on or after January 1, 2022 | Group health plans | Continuity of care | If a continuing care participant loses their benefits at a participating provider or facility because the plan’s contract with them ended, the plan must:
| Confirm that TPA and or carrier will comply. Revise contract language if necessary. If you are self-funded, review your stop-loss policy and update as needed. | The Departments intend to undertake rulemaking to fully implement this provision but rulemaking might not occur until after January 1, 2022. Until finalized rules are released, plans and issuers are expected to implement using good faith, reasonable interpretation. |
Plan years that begin on or after January 1, 2022 | Group health plans | Price comparison tool | Plan must provide price comparisons by phone and online | Confirm TPA and/or carrier will comply. Revise contract language if necessary. | Later this year, the Departments intend to issue regulations regarding the price comparison tool. |