Group Health Plans Must Affirm Compliance with Price Transparency Rule

January 17, 2024 | Leah Shepherd

Employers that sponsor group health plans need to ensure they are in line with a new annual requirement to vouch that they are complying with a federal price transparency rule.

The reporting requirement was part of the No Surprises Act, which passed in 2021 as part of the Consolidated Appropriations Act. It prohibits group health plans from entering into any agreement that prevents them from providing information on cost or quality of care to enrollees in the plan or referring providers. A health care provider, network or other service provider may place reasonable restrictions on the public disclosure of this information.

The agencies recently provided detailed instructions for submitting the attestation.

If a group health plan missed the 2023 deadline, “do it ASAP. Even if it’s late, send it in,” said

Anne Tyler Hall, an attorney with Hall Benefits Law in Atlanta.

Self-funded and partially self-funded health plans may satisfy the requirement by signing a written agreement under which the plan’s service provider, such as a third-party administrator, attests on its behalf. However, the health plan remains legally responsible if the third-party administrator fails to submit an attestation.

“The ultimate onus is on the plan sponsor,” Hall said.

The following entities are not required to submit an attestation:

  • Hospital indemnity or other fixed indemnity insurance plans.
  • Disease-specific insurance plans.
  • Dental, vision and long-term care plans.
  • Accident-only, disability and workers’ compensation plans.
  • Medicare and Medicaid plans.
  • State-run children’s health insurance plans.

Penalty for Violations

The penalties for noncompliance could add up. “Failure to file gag clause attestation could result in enforcement action, which may be a $100 per day excise tax under the Internal

Revenue Code or civil penalty under ERISA [Employee Retirement Income Security Act],” said Sage Fattahian, an attorney with Morgan Lewis in Chicago.

Violating the attestation requirement also could invite an IRS or U.S. Department of Lab or audit, Hall said. “They find plans that have one issue and their hypothesis is that, if they are not in compliance with this gag clause an attestation requirement, they’re probably not in compliance” with other laws, she noted.

Congress intended for the law to make provider-specific cost and quality information accessible to patients and health plans.

Patients often don’t know what a doctor will charge for services or procedures, such as an MRI or anesthesia. Comparing costs for different providers is often difficult.

“Increased transparency is an important driving force behind this and other regulatory requirements enacted under the Consolidated Appropriations Act” of 2021, Fattahian said.

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Hall Benefits Law, LLC

HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.

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