CAA Rule Changes: Employers as a Health Plan Fiduciary

CAA Rule Changes: Employers as a Health Plan Fiduciary

Changes to the Consolidated Appropriations Act are just around the corner as we prepare to enter into 2022. Under the new rules, many plan sponsors and employers are identified as fiduciaries, similar to existing retirement plan requirements. As we approach the CAA provisions enactment date, preparation is vital. 

Why the “Fiduciary” Tag is Important

When a plan sponsor is designated as a fiduciary, several critical compliance-related issues may arise as a result. It will be essential to review these potential gaps with your broker to ensure your organization is not at risk when the new CAA provisions are enacted. 

 An article from BenefitsPro highlights some steps to take:

  • Remove gag clauses from service provider contracts: Gag clauses prohibit full transparency of data. Plan sponsors will need to attest to the removal of these clauses by the end of the year. 
  • Establish reporting requirements for pharmacy prescriptions: Plan sponsors must report certain information like drug prices to the government. This information includes pricing, frequency of prescriptions, drug cost increases, premiums, rebates, and out-of-pocket costs. This reporting is required so there is evidence that plan sponsors are acting in the best interests of enrollees. 
  • Disclosure of direct and indirect compensation: The CAA requires the disclosure of direct and indirect compensation from service providers of over $1,000. We covered this topic in a previous CAA blog.
  • Required parity for substance abuse and mental health benefits: Plan sponsors must analyze non-quantitative treatment limitations on mental health/substance abuse benefits to show parity with medical and surgical care.

How To Prepare?

A trusted advisor can help you prepare to act as a plan fiduciary for your enrollees. There are a few items to begin with when preparing for these changes, and it will be essential to do so immediately as the implementation of the new CAA draws nearer. Your broker can work with you to fulfill these tasks to get started, which include:

  • Acknowledge your role as plan fiduciaries to your employees.
  • Establish a compliant fiduciary procurement process.
  • Become familiar with gag orders in your TPA/insurance agreements.
  • Know your healthcare and Rx data to fully comply with new regulations.

Join RCM&D for the next session in the Consolidated Appropriations Act webinar series. 

RCM&D is hosting a webinar series to help you prepare for the expected changes to your employee benefits plans as a result of the Consolidated Appropriations Act. We hope you can join us for the next session to discuss these important provisions. 


If you have any questions about the new CAA rules or employers as a health plan fiduciary, talk to an RCM&D advisor today.