The departments of Labor, Health and Human Services, and Treasury have released FAQ guidance delaying the enforcement of certain requirements under the Transparency in Coverage Final Rule1 and the No Surprises Act (NSA) — part of the Consolidated Appropriations Act (CAA)2 — “pending further rulemaking.”
The departments also announced in the FAQs that they will not be issuing regulations for several provisions of the NSA.
Among the guidance, the FAQs provide that:
Additional timing and details are listed in the chart below.
| Original effective date | New effective date | Additional comments | |
|---|---|---|---|
| Prescription drug machine readable file (Q&A 1) |
January 1, 2022 | TBD | Deferred until future rulemaking determines whether the rule is appropriate |
| In-network rates and out-of-network allowed amounts and billed charges machine readable files (Q&A 2) |
January 1, 2022 | July 1, 2022 | Employers should continue to work with carriers/third-party administrators to plan to comply |
| Price comparison tools (Q&A 3) |
January 1, 2022 under CAA Phased in from January 1, 2023, to January 1, 2024, under Transparency in Coverage Final Rule |
TBD, but not effective before plan years beginning on or after January 1, 2023 | To be resolved via future rulemaking |
| Revision of insurance ID cards (Q&A 4) |
January 1, 2022 | TBD — No regulations will be issued prior to January 1, 2022 | Good faith, reasonable interpretation of the law will be in effect until guidance is issued To be resolved via future rulemaking |
| Advanced EOBs (Q&A 6) |
January 1, 2022 | TBD — No regulations will be issued prior to January 1, 2022. | To be resolved via future rulemaking |
| Prohibition on gag clauses on price and quality information (Q&A 7) |
December 27, 2020 | N/A — Statutory language is self-implementing | Good faith, reasonable interpretation of the law will be in effect until guidance is issued Departments will provide implementation guidance in the future in order to collect attestations starting in 2022 |
| Accuracy of provider directories (Q&A 8) |
January 1, 2022 | TBD — No regulations will be issued prior to January 1, 2022 | Good faith, reasonable interpretation of the law will be in effect until guidance is issued To be resolved via future rulemaking |
| Balance billing disclosures (Q&A 9) |
January 1, 2022 | TBD — No regulations will be issued prior to January 1, 2022 | Good faith, reasonable interpretation of the law will be in effect until guidance is issued To be resolved via future rulemaking |
| Continuity of care (Q&A 10) |
January 1, 2022 | TBD — No regulations will be issued prior to January 1, 2022 | Good faith, reasonable interpretation of the law will be in effect until guidance is issued To be resolved via future rulemaking |
| Reporting of pharmacy benefits and drug costs (Q&A 12) |
December 27, 2021 | December 27, 2022 | Deferred until future rulemaking, but group health plan sponsors are strongly advised to prepare for reporting on 2020/2021 by December 27, 2022 |
1 See “Q&A: Final rule on health care transparency,” Insider, November 2020
2 For more information on the CAA’s surprise medical billing and transparency requirements, see “2020 year-end COVID-19 stimulus law: Health and benefit implications,” Insider, January 2021.
| Title | File Type | File Size |
|---|---|---|
| Insider September 2021 | .3 MB |
