Stay in the know
WebTPA is committed to keeping its clients up to date on federal healthcare policies and legislation. Here you will find our interpretation of said legislation and how these statutes may impact your health plan.
Publicly Available, Machine-Readable Files
In-Network Rates and Historical Out-of-Network Allowed Amounts
To meet transparency requirements effective July 1, 2022, WebTPA will assist plan sponsors in making the two machine-readable files available (in-network rates for covered services or item covered by the plan, historical billed charges from out-of-network providers and the allowable amount of such charges considered by the plan).
Important Note
These are very large JavaScript Open Notation (JSON) files (20GB to 70GB) that may take a while to download. If your system has limited capability, they may not be downloadable. Download speeds and time are dependent on your internet speed, browser and computer hardware.
DOL, HHS & Treasury FAQ's
In this week’s WebTPA Compliance Update, we provide updates to key portions of recent federal legislation and recap on major requirements of this legislation.
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Federal Regulations: Highlights and Recap
Last Friday, August 20, the Departments of Labor, Health and Human Services, and the Treasury (the Departments) issued new frequently asked questions (FAQs) regarding implementation of the Transparency in Coverage (TIC) regulations and the Consolidated Appropriations Act of 2021 (CAA), which includes the No Surprises Act (NSA).
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Transparency in Coverage Rule
The Transparency in Coverage Rule requires hospitals, health insurers and group health plans to provide various pricing files and tools to the public over the course of a multi-year rollout of health care cost data.
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NSA
The Interim Final Rule was issued by the U.S. Office of Personnel Management and the Departments of Health and Human Services, Labor, and Treasury on July 1, 2021 and takes effect January 1, 2022.
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Interim Final Rule
The first interim final rule explaining how to implement provisions of the No Surprises Act (NSA) was released by the Biden administration on Thursday, July 1, 2021.
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Federal Regulations Updates
In this week’s Compliance Update, we have provided updates on Mental Health Parity NQTLs and an upcoming webinar by the DOL; HSA contribution limits for 2022; ACA Section 1557 and recent IRS guidance on COBRA subsidies.
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Nonquantitative Treatment Limitations (NQTLs)
In our previous Compliance Update, WebTPA mentioned the nonquantitative treatment limitations (NQTLs) comparative analysis, under the Mental Health Parity and Addiction Equity Act (MHPAEA). Group health plans must apply any processes, strategies, evidentiary standards and other factors underlying NQTLs to mental health or substance use disorder (“MH/SUD”) benefits comparably to those for medical/surgical (M/S) benefits.
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No Surprises Act
On October 29, 2020, HHS, the Department of Labor, and the Department of Treasury (the Departments) jointly issued a final rule requiring health plans to disclose price and cost-sharing information to participants, beneficiaries, enrollees and the general public.
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COBRA Tolling Period Extensions
As communicated earlier this month, WebTPA has been working to identify the individuals affected by the COBRA tolling period extensions. By the end of this week, our goal is to provide our clients with a copy of the COBRA Election Extension Period Notice and the COBRA Election Extension Period Expiration Notice.
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American Rescue Plan Act of 2021
The $1.9 trillion bill includes direct economic impact payments for qualifying individuals and families, extended unemployment benefits, temporarily extended child tax credits, and funding for education, public health, and other pandemic response priorities.
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COVID-19: Health Plan Timeframe Extensions
On May 7, 2020, WebTPA provided information regarding the extension of certain health plan timeframes due to the COVID-19 pandemic (EBSA Disaster Relief Notice 2021-01).
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