The Washington Report
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August 25, 2021
Health
Departments Release FAQs About ACA and CAA Implementation Part 49
On August 20, 2021, the Departments of Labor, Health and Human Services (HHS), and the Treasury (the Departments) released 12 frequently asked questions (FAQs) regarding implementation of certain provisions of the Affordable Care Act (ACA) and certain provisions of title I (the No Surprises Act) and title II (Transparency) of Division BB of the Consolidated Appropriations Act, 2021 (the CAA). The questions address:
- Transparency in Coverage (TiC) machine-readable files;
- Price comparison tools;
- Transparency in plan or insurance identification cards;
- Good faith estimate;
- Advanced Explanation of Benefits;
- Prohibition on gag clauses on price and quality data;
- Continuity of care;
- Grandfathered health plans; and
- Reporting on pharmacy benefits and drug costs.
The questions include:
- Will the Departments enforce the machine-readable file provisions in the TiC Final Rules?
- Are plans and issuers required to make public the machine-readable files for in-network rates and out-of-network allowed amounts and billed charges for plan years (in the individual market, policy years) beginning on or after January 1, 2022?
- How do the different regulatory and statutory requirements for the self-service price comparison tools under the TiC final rules and the CAA interact?
- Will the Departments be issuing regulations addressing the ID card requirements prior to the effective date?
- Will HHS be issuing regulations addressing the Good Faith Estimate requirement prior to the statutory effective date?
- Will the Departments be issuing regulations addressing the Advanced Explanation of Benefits prior to the effective date of January 1, 2022?
- Will the Departments be issuing regulations addressing the prohibition on gag clauses?
- Will the Departments be issuing regulations addressing the provider directory requirements prior to January 1, 2022?
- Will the Departments be issuing regulations addressing the balance billing disclosure requirements applicable to plans and issuers prior to the effective date of the requirements?
- Will the Departments be issuing regulations addressing the continuity of care requirements prior to January 1, 2022?
- Are grandfathered health plans generally subject to the requirements under the CAA?
- How do the Departments intend to implement the reporting requirements for plans and issuers to submit information to the Departments related to pharmacy benefits and drug costs?
Please refer to the FAQs for specific details and guidance.
The FAQs are available here.
Departments Intend to Propose Changes to 2018 Regulations on Preventive Services Coverage Requirements
On August 16, 2021, the Departments issued an FAQ regarding implementation of the ACA. According to the FAQ, the Departments intend to issue proposed regulations that would amend final regulations published in the Federal Register on November 15, 2018, on the requirements for the coverage of certain preventive services.
The FAQ is available here.