New Regulatory Requirement
When the Consolidated Appropriations Act (CAA) was signed into law in late 2020, in addition to sweeping pandemic relief and stimulus measures, it also included a number of provisions pertaining to group health plans.
When the Consolidated Appropriations Act (CAA) was signed into law in late 2020, in addition to sweeping pandemic relief and stimulus measures, it also included a number of provisions pertaining to group health plans.
As part of a substantial set of stipulations aiming to minimize billing surprises for participants and improve plan accountability and transparency overall, the CAA clarified the role of the plan sponsor as fiduciary, with four key requirements:
Remove service provider gag clauses.
Plan sponsors must attest that they have full contractual access to cost and quality information
that service providers traditionally have limited.
Report prescription data.
Plan sponsors must report detailed information about prescriptions, including costs, how frequently drugs are dispensed and the impact of rebates, fees and other forms of renumeration on employee premiums.
Disclose service provider compensation.
Plan sponsors are required to obtain a comprehensive list of any direct or indirect compensation over $1,000 received by service providers in connection with their work for the health plan.
Achieve parity in substance abuse and mental health benefits.
Plan sponsors must demonstrate that mental health and substance abuse benefits are not subject to more non-quantitative treatment limitations (NQTLs) than are medical or surgical care benefits. Examples of NQTLs could be care restrictions based on provider type or requirements for prior authorization.
Together with other elements of the CAA, these provisions are expected to ensure that group health plans are structured to benefit participants. However, compliance with the new CAA provisions is a substantial undertaking — with the burden placed squarely on plan sponsors. FNB’s Insurance team is working closely with clients while they execute a four-step process:
In any environment, shifting regulatory requirements can pose significant risk for businesses that lack mechanisms to stay current and compliant. A knowledgeable partner can be key to a company’s success.
Contact an FNB Insurance expert at 1-800-252-4850 to discuss strategies to navigate the CAA legislation and improve outcomes for your teams.