CAA Prescription Data Collection Reporting

October 12, 2022

This notice provides information regarding WebTPA’s plans to assist our clients with their CAA Section 204 reporting obligations. We previously shared an overview of the reporting requirements, and we asked a few questions pertaining to your Plan’s submission of the various files. We have also been communicating with many of the PBM partners that our clients utilize to ensure that we are in sync with how they intend to submit data on behalf of our joint clients. Please note that this particular reporting exercise is largely prescription drug data, so the data that WebTPA will be able to provide in support of our clients, will be rather limited in scope.
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ACA and IRS Dollar Limits

September 27, 2022

The U.S. Department of Health and Human Services (HHS) finalized an increase in the annual limit on cost-sharing for essential health benefits for non-grandfathered plans that apply to plan years beginning on or after January 1, 2023.
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CAA Rx Reporting

August 26, 2022

The Consolidated Appropriations Act, 2021 (CAA) requires plans and issuers to submit information regarding the costs of prescription drugs and other health care services each year to the Center for Medicare & Medicaid Services (CMS). The rule generally applies to group health plans and health insurance issuers offering group or individual health insurance coverage. The term ‘‘group health plan’’ encompasses both self-funded and insured health plan, including employer-sponsored group health plans subject to ERISA, non-federal governmental plans (such as plans sponsored by states and local governments) subject to the Public Health Services (PHS) Act, and church plans subject to the Internal Revenue Code. Individual health insurance coverage includes student health insurance coverage. Plans consisting only of HIPAA excepted benefits do not have to comply.
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Upcoming PCORI Deadlines

July 26, 2022

At the end of 2021, the IRS raised the fee that insurers and sponsors of self-insured health plans pay annually to fund the federal Patient-Centered Outcomes Research Institute (PCORI) trust fund.
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Federal Legislation for Self-Funded Health Plans

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.

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