On December 27, 2020, the Consolidated Appropriations Act (CAA) was enacted. The Act is a COVID-19 relief package that also includes the most significant health care legislation since the Affordable Care Act (ACA). These provisions include consumer protections from surprise medical bills, continuity of care protections, enhanced mental health parity requirements, and several new provisions designed to increase the transparency of health care costs.

The legislation, which goes into effect as plans renew next year unless otherwise noted, gives consumers transparency and financial peace of mind when seeking care. Additionally, the provisions ensure that patients remain protected from unnecessary expenses for their medical treatment. We’ve highlighted some of these provisions below.

Continuity of Care Protections

  • Patients remain protected if a provider leaves a plan’s network. A patient will have the ability to continue care with that provider for an additional 90 days.
  • Health plans are required to maintain up-to-date directories of network providers and must make them available online and to the public. If a patient provides documentation that he or she was provided inaccurate information from a plan insurer about a provider’s network status prior to treatment, the patient will only be responsible for the in-network amount.

Transparency of Costs and Surprise Billing Protections

  • Plans must also accommodate requests for expanded external reviews following an adverse benefit determination in the event surprise billing protections can be applied.
  • Effective January 1, 2023, participants will have the ability to compare costs for services when seeking care. Plans will be required to provide a price comparison tool that enables participants to compare costs of in-network provider services in specific locations.
  • There will be additional requirements for plans to provide advance Explanation of Benefits they receive from providers, including good faith estimates on cost-sharing. Enforcement of this provision has been delayed pending further rulemaking.
  • Health plans will be required to provide timely responses to claims processing and make initial payment or denials within 30 days of receipt of claims. Health plans will also be required a 30-day resolution period to settle out-of-network claims.
  • Balanced billing is also prohibited in certain situations. Facilities or providers will not balance bill for more than the network cost sharing amount.
  • Providers are required to provide good faith estimates and verify a patient’s coverage type at least three days in advance of providing a service (and not later than one day after service is scheduled), regardless of patient coverage.
  • Plans will be unable to enter contracts that bar the disclosure of information relating to provider cost and quality.
  • Brokers will be required to disclose his/her direct or indirect compensation to the plan fiduciaries.

Additional Provisions

New FSA requirements will allow employers to provide employees with additional time to use their funds. Employees can rollover unused balances from a plan year ending in 2020 to a plan year ending in 2021, and from a plan year ending in 2021 to plan year ending in 2022.

The legislation also requires that all health care ID Cards must list the deductible and out-of-pocket maximum amounts for plans effective January 1, 2022. WGAT will re-print ID cards to comply with the Health Transparency Act, and we are also taking this opportunity to improve the format of our ID card to make it easier to read for plan participants and providers.

As always, WGAT remains committed to serving you and helping its partners navigate through these provisions as seamlessly as possible. We’re here to help with any questions regarding these new requirements. Please contact your WGIS account manager with any questions or concerns.