On December 23, 2022, the U.S. Department of Labor (DOL), the U.S. Department of Health and Human Services (HHS), and the U.S. Department of the Treasury (collectively, “the Departments”) issued joint FAQs concerning certain provisions of the Consolidated Appropriations Act 2021 (CAA). The FAQS relate to the implementation of Title II (Transparency) of Division BB of the CAA, which addresses the mandatory reporting of selected prescription drug and health care spending by group health plans and health insurance issuers.
The Departments and the Office of Personnel Management (OPM) issued interim final rules in November 2021 indicating that the Departments would not take enforcement action against plans or issuers who failed to report the required information by the first or second statutory deadlines. Those deadlines occurred on December 27, 2021, and June 1, 2022. Instead, the Departments and OPM required that the plans and issuers submit all such information by December 27, 2022.
In the most current FAQs, the Departments state that they will not take enforcement action against any plan or issuer that uses a “good faith reasonable interpretation of the regulations and the Prescription Drug Collection (RxDC) Reporting Instructions” in making its submission. They also are extending the statutory deadline to January 31, 2023, in that they will not consider any plan or issuer out of compliance so long as they submit their mandatory 2020 and 2021 data before that date.
The Departments are providing some flexibilities for the 2020 and 2021 reporting requirements only, including the following:
- Allowing multiple submissions by the same reporting entity;
- Allowing submissions by multiple reporting entities;
- Suspending the aggregate restriction on submitted data;
- Allowing certain group health plans to submit premium and life-year data by email;
- Making reporting on vaccines optional; and
- Making the duty to report amounts not applied to the deductible or out-of-pocket maximum optional.
Finally, the Departments pledged to monitor stakeholder efforts to determine whether further guidance would be necessary in advance of future reporting deadlines.
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