No Surprises: Group Health Plans Must Up Transparency in 2022

No Surprises: Group Health Plans Must Up Transparency in 2022
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New legislation regarding provider pricing transparency in the Consolidated Appropriations Act (CAA) and other laws taking effect in January 2022 are creating a compliance whirlwind. Last month, we discussed the CAA's impact on holding brokers accountable regarding fee transparency. This month, we dive into pricing disclosures. 

What is Changing in 2022?

Beginning in January 2022, health plan enrollees in both self-insured and fully insured plans will have the power to choose their coverages more freely. An article from the Society for Human Resource Management (SHRM) highlights several changes as part of the Transparency in Coverage rule passed in November 2020 by the Department of Labor, Treasury, and HHS, as well as additional changes to the Consolidated Appropriation Act (CAA) that will also impact this topic.

Under the new Transparency in Coverage rule, employers will be required to provide employees with out-of-pocket expense estimates for services from a variety of health care providers, allowing plan members to easily shop and compare costs for services before scheduling care.

Other significant changes come from the new Consolidated Appropriations Act (CAA) rules, mainly the "No Surprises Act." The No Surprises Act contains several key measures aiming to increase transparency. Some of these changes include:

  • Removal of gag clauses: Plan providers may no longer have restrictive contract language that prevents and blocks plan sponsors from accessing information regarding cost and quality of care. 
  • Compensation disclosure: All plans must disclose payments of $1,000 or less made to brokers or consultants.

With this myriad of changes, all of which set to occur at once, proper preparation will be essential to stay in compliance.

How to Prepare

Staying in compliance and ensuring employees are getting the best value and most adequate care starts with getting ahead of these new pricing transparency rules. Creating a long-term plan to educate employees and emphasize the importance of shopping for care is critical to readying your organization for the changes on the horizon. 

As a broker, RCM&D  stands ready to help your organization educate your employees and stay in compliance. We have always believed in transparency with our customers and are excited to see employers and employees alike benefit from receiving best-in-class care at an appropriate cost.

Webinar Series

Over the next few months, we will be releasing new blogs and hosting webinars so you can learn more about the CAA and how it will impact your organization. We hope you will join us for these sessions:

Questions?

These new provisions under the CAA and beyond are exciting news for employers but require preparation.

If you have any questions about the new CAA rules or provider pricing transparency, talk to an RCM&D advisor today.


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