Hot off the Press
On Friday 8/20, the Department of Labor issued an update around the timeframe and enforcement of both Transparency in Coverage and the No Surprises Act for payer price transparency. The forthcoming laws complement the Hospital Price Transparency Rule in making it easier for patients to compare care costs, avoid surprise bills and know the price of care in advance. Responding to industry pressure, the DOL has delayed enforcement for various requirements by 6-12 months.
We'll have a lot of thoughts on this and what it means for rolling out ubiquitous price transparency in healthcare. For many, it will now feel like Christmas in July. Here's our quick summary of the 11-page document while the news is still fresh.
Regarding Machine Readable File Requirements for Transparency in Coverage (TiC)
- See you in six months: The In Network and Out of Network file requirement will not be "enforced" until July 1, 2022. Payers now have an extra six months to prepare.
- The TiC Prescription Drug machine readable file requirement, seen as potentially duplicative with Section 204 of the No Surprises act, will be deferred indefinitely for further rule making (see below).
Price Comparison Tool Requirements of TiC and No Surprises Act (NSA)
- My price comparison tool or yours? Because the NSA and the TiC Price Comparison tool requirements were seen as largely duplicative, the NSA 1/1/22 deadline has been moved back to align with the TiC 1/1/23 date. It appears the departments are merging these requirements in the industry's mind. There is no longer a federal price comparison tool requirement for 1/1/22.
- Call me maybe: The NSA Price Comparison Tool required estimate by phone, while TiC did not. The departments will look into adding the phone requirement to TiC in further rule making.
Good Faith Estimate of Charges + Advanced EOB (No Surprises Act)
- Computers are hard: The requirement for providers to furnish Good Faith Estimates is deferred until further rule making is issued, due to the technical complexity of the requirement.
- The requirement for payers to furnish Advanced EOBs is also delayed until further rule making and technical standards are issued.
- One Turquoise plug here: we're working with others in industry to create an open source standard for Good Faith estimates & Advanced EOBs by the end of 2022. This should serve as an out of the box solution for the technically challenged (and give them no excuses for compliance). So let's not wait too long.
Prohibition on Gag Clauses on Price and Quality Data
- Still gone: The prohibition of Gag Clauses stands. Plans and issuers are expected to comply in Good Faith until guidance is issued on how to attest to compliance in 2022.
Provider Directory Requirements (from NSA)
- Mum's the word: No further rule making will come out until 2022.
- Until then, plans and issuers should comply in good faith and limit cost share to in-network amounts for patients who received out of network care under inaccurate information.
- Balance billing requirements stand, and plans and issuers are expected to implement these in good faith until further guidance is issued.
Prescription Drug Cost Reporting Requirements (from NSA)
- Additional regulations are forthcoming.
- This reporting requirement is delayed until December 27, 2022, it seems? (read this one for yourself!):
"Accordingly, the Departments will defer enforcement of the requirement to report the specified information by the first deadline for reporting on December 27, 2021 or the second deadline for reporting on June 1, 2022, pending the issuance of regulations or further guidance. Until regulations or further guidance is issued, the Departments strongly encourage plans and issuers to start working to ensure that they are in a position to be able to begin reporting the required information with respect to 2020 and 2021 data by December 27, 2022. "
Other relevant, non-price transparency topics touched in the FAQ:
- Insurance ID Card requirements from No Surprises Act (page 4)
- Continuity of Care requirements (page 9)
- Grandfather Health Plans being subject to NSA but not TiC (page 9)