Now in Effect: New Healthcare Price Transparency Rules

3-minute read

The Consolidated Appropriations Act imposed a string of new requirements on group health plans, including new reporting requirements and limitations on surprise billing and balance billing.

The latest deadline for one of the most important consumer-protection provisions in the law came and went with what we suspect was inadequate notice.

The Consolidated Appropriations Act imposed new healthcare price transparency requirements on employer plans.

As of July 1, 2022, companies with a group health plan were expected to make two “machine readable files,” or “MRFs,” of in-network and out-of-network pricing information available on their public-facing websites.

You read that correctly. Not their company intranet, not their breakroom bulletin boards, not their employee handbooks. These files must include detailed information related to covered items, services, and pricing, including cost-sharing amounts, and must be posted on the internet.

The hope, of course, is to take the mystery out of what Americans’ out-of-pocket costs might be and dampen the rise in healthcare spending – a goal we can all applaud.

The tricky part is in getting it right. Assuming your company is still racing to get into compliance – as many are – here are a few items to keep top of mind:

  1. You are not required (and should not) disclose information that would violate health privacy laws.
  2. The MRFs must be updated monthly and clearly note the date they were last updated.
  3. Paper copies of your MRFs must be available upon request.
  4. Any website you use to post your MRFs may not require the establishment of a user account, passwords or other credentials to access the MRFs.
  5. You may turn to a third-party administrator to post the MRFs but are still required to provide a link on your own public website to the MRFs.

As you might expect, there’s more to this, including this important note:

Companies that fail to ensure these requirements are met can expect government regulators to hold them responsible. They can also expect to potentially hear from a plaintiffs’ attorney. Hiring a TPA to help is fine but you, the employer, still retain the fiduciary responsibility to get this done right.

If you have questions about these or any of the requirements in the Consolidated Appropriations Act, contact a member of The Mahoney Group’s Employee Benefits team.

The Mahoney Group, based in Mesa, Ariz., is one of the largest independent insurance and employee benefits brokerages in the U.S. An employee-owned organization, we’ve been providing our clients with the confidence to face whatever lies ahead for more than 100 years. For more information, contact us online or call 877-440-3304.

This article is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice.

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