Protected: New Compliance Federal Requirement Related To Gag Clauses In Group Health Plan Contracts
The Consolidated Appropriations Act 2021 (CAA-21) forbids group health plans or those who offer group health insurance from taking part in contracts with other health care entities that have certain gag clause language. As of February 23, 2023, the Departments of Health and Human Service, Labor and Treasury collaborated on the FAQ Guidance to clarify issues with CAA-21. Health plans and insurers are required to submit documentation for compliance of the CAA-21 gag clause as per the FAQs. Read more about the latest federal compliance related to gag clauses from Departments jointly issued FAQ guidance.
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Important Compliance Dates for 2023
With summer just around the corner, several key compliance dates lay just ahead beginning in June 2023.
The 2022 RxDC reporting data is due on June 1, 2023. While insurance providers, PBMs, and third party claims may submit the data, it is ultimately up to the employer to ensure the data is sent on time.
PCORI fees must be paid by July 31, 2023. Groups that are self-funded, level-funded, and those offering access to health reimbursement arrangements are required to use IRS Form 720 to submit their PCORI fees.
For group health plans of 100 or more employee participants at the first day of the plan year, Form 5500 with the DOL and IRS is required by the last day of the seventh month from the start of the plan year. If your health plan begins on January 1, 2023, the Form 5500 date would then be July 31, 2023.
The last day to notify all medicare-eligible group participants of the Medicare Prescription Drug Creditable Coverage Disclosure Notice is October 15, 2023.
Health plans should update their online participant-specific plan transparency tool by January 1, 2024. This update should include all treatments and services covered.
COVID-19 and End of Public Health Emergency Update:
As of May 11, 2023 the Public Health Emergency (PHE) regarding COVID-19 will end. United Healthcare has worked closely with several government agencies to create a standard approach for COVID-19 following the May 11 decree. United Healthcare’s standard approach is applicable for level-funded, fully insured plans; they are also recommending that self-funded customers follow the same standard coverage. United Healthcare post-PHE standard approach has been developed to return to normal benefit plans in a consistent and timely manner. For more information on the latest PHE information, see Unit Healthcare’s recent update.