Both the Consolidated Appropriations Act and the “Transparency in Coverage” regulations are potential game changers, affecting how health plans set prices for services, negotiate provider contracts and pay for out-of-network emergency care, report information and provide disclosures to participants.
These substantial new requirements will be effective for plan years beginning on or after 2022.
Attorney Howard Lapin, Actuary Steve Cyboran, and Attorney Larry Grudzien conducted a new free webinar reviewing the requirements for the Consolidated Appropriation Act and the “Transparency in Coverage” regulations on July 20 at 1 PM CDT.
The Webinar was 90 minutes in length.
The following questions were discussed:
Preventing Surprise Billing:
-What new requirements will be imposed to prevent surprise billing? General Transparency:
-What new requirements must be added to insurer and TPA contracts to meet the new transparency requirements? -What new EOBs must be provided to participants before any scheduled care? -What new services must be provided to a “continuing care patient”? -What new price comparison guidance must to be provided by phone or Plan website to participants? -What new advanced explanation of benefits must be provided to participants if requested for scheduled services? -What new provider directories must be provided and how often must they be updated? -What new disclosures must be made to the plan for broker, TPA and other vendor fees?
Mental Health Parity Transparency:
-What detailed comparative analysis must be provide to governmental agencies if the plan provides both medical/surgical benefits and mental health/substance abuse benefits?
Reporting:
-What new reporting must be made to governmental agencieson drug prices?
Transparency in Coverage:
-What information must a health plan publicly report on negotiated in-network and out-of-network amounts? -What information must health plans provide to participants on cost sharing?
The webinar will cover all these questions and more.
We will also provide suggested steps for employers, brokers and TPAs to comply to meet these new reporting and disclosure requirements. Do not be unprepared in 2022!
To avoid any technical issues, we are limiting the registration to this webinar to 500. If you are unable to register to this webinar, we will add another webinar. This Webinar has a question and answer period.
