On Aug. 20, 2021, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued frequently asked questions (FAQs) regarding the implementation of the No Surprises Act and transparency provisions of the Consolidated Appropriations Act, 2021 (CAA).

Due to the rapid implementation timeline, the Departments will defer enforcement of some provisions, including the following:

    • Transparency in coverage machine-readable files related to prescription drug pricing (pending further rule-making)
       
    • Other types of machine-readable files (until July 1, 2022)
       
    • Price comparison tool (until Jan. 1, 2023 to align with Transparency in Coverage applicability date)
       
    • Good faith estimate of expected charges and Advanced Explanation of Benefits (pending further rule-making)
       
    • Pharmacy benefit and drug costs reports (pending further rule-making)
      Plans/issuers should prepare to begin reporting 2020 and 2021 data by December 27, 2022.

The Departments plan to issue regulations on the provisions below, likely after January 1, 2022. In the interim, plans and issuers are expected to use good faith, reasonable interpretations of the statute.

    • Interaction of the CAA and the Transparency in Coverage Final Rules
    • Provider directory
    • Continuity of care

Regulations are not expected to be issued on the following provisions; therefore, the good faith, reasonable interpretations of the statutory standard will apply.

    • Gag clauses prohibition
    • Balance billing disclosure

Lastly, the Departments provided an example of a plan or insurance identification card that would be compliant with the transparency requirements for those cards and clarified that grandfathered health plans are generally subject to the CAA’s requirements.

If you have questions or need help, please contact one of our benefit consultants.


This blog and its contents are not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.