The Consolidated Appropriations Act, 2021 (CAA) and the Affordable Care Act’s Transparency in Coverage (TiC) Final
Rules contain an array of provisions impacting employer-sponsored group health plans. Increasing transparency is the
name of the game.
In August 2021, the Department of Labor (DOL), Health and Human Services (HHS), and Treasury (collectively, the
Departments) released FAQs on the CAA and TiC Rules. Enforcement of several of the more demanding provisions of
the TiC Rule have been delayed. But some provisions of the CAA are already in effect and other CAA and TiC provisions
are required to be implemented for plan or policy years beginning on or after January 1, 2022. While most requirements
related to claims or advance disclosures of costs will be handled by the third-party administrator (TPA) or carrier,
employers as plan sponsors should do their due diligence as outlined below to demonstrate good faith efforts to
ensure compliance. For provisions without additional regulatory guidance, plan sponsors will be held to a good faith and
reasonable interpretation of the law.
Table of Contents
Mental Health Parity Addiction Equity Act (MHPAEA) – Comparative Analysis .................................................... 2
Surprise Billing for Emergency and Non-Emergency Services ................................................................................ 3
Surprise Air Ambulance Billing ................................................................................................................................ 3
Surprise Billing Independent Dispute Resolution ................................................................................................... 4
Disclosures on Patient Protections Against Surprise Balance Billing...................................................................... 4
External Review of Surprise Medical Bills ............................................................................................................... 5
Surprise Air Ambulance Service Reporting Requirements ..................................................................................... 5
Provider Directories ................................................................................................................................................ 6
Insurance ID Card Information................................................................................................................................ 7
Continuity of Care ................................................................................................................................................... 7
Removal of Price and Quality Data Gag Clauses ..................................................................................................... 8
Additional CAA and TiC Requirements on the Horizon .......................................................................................... 9
Checklist of CAA and TiC Compliance Steps – Fully-Insured Plans ....................................................................... 10
Checklist of CAA and TiC Compliance Steps – Self-Funded/Level-Funded Plans ................................................. 11
See Attachments