As certain provisions of the Consolidated Appropriations Act, 2021 (CAA) take hold for plan fiduciaries, four bipartisan bills to expand on those reforms have been introduced in the House of Representatives to “help employers meet their obligation to ensure that their workers’ premium dollars are spent carefully.”
Education and the Workforce Committee Chairwoman Virginia Foxx (R-NC) and Ranking Member Robert C. “Bobby” Scott (D-VA) announced the introduction of a bipartisan health care package comprised of four bills introduced by committee members. According to a press release, the package works “to increase cost transparency for employers and patients, lower premiums and reduce health care spending, and increase competition by removing incentives for provider consolidation.”
Of particular interest to plan sponsors:
Health DATA Act: Authored by Rep. Lori Chavez-DeRemer (R-OR), Rep. Mark Takano (D-CA), and Rep. Kathy Manning (D-NC), the bill “ensures health plan fiduciaries are not contractually restricted from receiving cost or quality of care information about their plan.”
Hidden Fee Disclosure Act: Authored by Rep. Joe Courtney (D-CT) and Rep. Erin Houchin (R-IN), the bill “strengthens requirements that PBMs and Third-Party Administrators (TPAs) disclose compensation to plan fiduciaries.”
The package also includes:
Transparency in Billing Act: Authored by Chairwoman Foxx (R-NC) and Ranking Member Bobby Scott (D-VA), which “requires accurate billing practices by hospitals, ensuring that group health plans pay for appropriately billed services.”
Transparency in Coverage Act: Authored by Health, Employment, Labor and Pensions (HELP) Subcommittee Chairman Bob Good (R-VA) and Ranking Member Mark DeSaulnier (D-CA), the bill codifies the “Transparency in Coverage” final rule, which provides consumers with price transparency for medical services and prescription drugs, and “brings much needed light to Pharmacy Benefit Managers’ (PBMs) business practices.”
As noted above, the provisions build on the Consolidated Appropriations Act of 2021, which requires, among other things, a determination of “reasonableness” of vendor fees and services for healthcare, as well as prescription drug reporting for plan years 2020, 2021, and 2022.[1] It also has been cited as a potential litigation “opportunity” for the plaintiffs’ bar. Last week Kraft Heinz sued its TPA (Aetna) for withholding information that would allow a review of their claims processing costs and practices.
See also an article in the Summer issue of NAPA Net the Magazine: https://issuu.com/usaretirement/docs/_nntm_sum23_complete_issuu/40
[1] The reporting deadline for the 2020 and 2021 calendar years was extended until Jan. 31, 2023. For calendar year 2022 and all subsequent years, reporting is due annually by June 1 following the close of the calendar year (e.g., reporting for calendar year 2022 was due June 1, 2023).
