The No Surprises Act (NSA), enacted as part of the Consolidated Appropriations Act, 2021 (CAA), includes transparency provisions requiring group health plans to report information on prescription drugs and health care spending to the Department of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments). This requirement applies to group health plans and health insurance issuers in the individual and group markets but does not apply to account-based plans and excepted benefits.
The NSA required the report be provided by Dec. 27, 2021, and by June 1 of each year thereafter. However, an interim final rule deferred enforcement of the initial deadline to Dec. 27, 2022. The Departments strongly encourage plans and issuers to start working to ensure that they are in a position to be able to report the required information. The Departments further encourage plans and issuers that are able to submit the required information by either the Dec. 27, 2021, or June 1, 2022, statutory deadlines to do so.
The NSA requires group health plans and health insurance issuers offering coverage in the group and individual markets to report certain information on plan medical costs and prescription drug spending to the Departments. Specifically, plans must report the following:
The majority of this information may be submitted on an aggregate basis across plans in the same state and market segment. However, the following information cannot be aggregated and must be reported separately for each plan:
The reporting requirement applies to both grandfathered and non-grandfathered group health plans and health insurance issuers in the individual and group markets. However, it does not apply to account-based plans (such as health reimbursement arrangements) and excepted benefits.
Plans and issuers may satisfy these reporting obligations by having third parties – such as issuers, third-party administrators (TPAs) or pharmacy benefit managers (PBMs) – submit some or all of the required information on their behalf. To do this, a plan or issuer must enter into a written agreement with the third party providing the information on its behalf in accordance with the interim final rules. Group health plans are not prohibited from reporting the required information on their own, but the Departments expect this to be rare.
This is an annual reporting requirement; plans and issuers will generally submit these reports in June each year, reporting information for the prior calendar year. The NSA required the report be provided by Dec. 27, 2021, and by June 1 of each year thereafter. However, the Departments anticipate that plans and issuers may need additional time to:
As a result, the Departments deferred enforcement of the initial reporting requirement to Dec. 27, 2022. The first annual statutory reporting deadline is June 1, 2022. The Departments strongly encourage plans and issuers that are able to submit the required information by either the Dec. 27, 2021, or June 1, 2022, statutory deadlines to do so. HHS encourages states that are primary enforcers of this requirement with regard to issuers to take a similar enforcement approach and will not determine that a state is failing to substantially enforce this requirement if it does so.
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