Compliance Corner

Topic: 2023 Benefits Compliance Highlights and Recap

To close out the year, the Benefits Compliance team will recap benefits-related legislative, regulatory, and judicial highlights from 2023. They will also look forward to 2024 and any potential guidance that may be on the horizon.

Note: The speakers will answer as many questions as possible during the webinar. If your question isn’t answered, reach out to your advisor for further assistance.

Date/Time: December 13, 2023
3:00 to 4:00 p.m. ET

Register Now

This program is pending approval for 1.0 (general) recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more information about certification or recertification, visit the HR Certification Institute website at hrci.org.

Note: Those listening to a recorded webinar will not be eligible for credit.

The deadline for the first CAA gag clause attestation is fast approaching! Employers should act now to ensure their group health plan contracts are compliant and attestations are timely submitted.

The CAA prohibits group health plans and insurers from directly or indirectly entering contracts offering access to provider networks that contain certain types of gag clauses. In the healthcare context, “gag clauses” are contract terms that restrict information, including provider network rates and de-identified claims data, that plans or insurers can make available to another party, such as a business associate.

Additionally, the CAA requires plans and insurers to annually attest to compliance with the gag clause prohibition via a CMS web form. The first attestation of compliance is due by December 31, 2023, attesting to compliance for contracts entered from December 27, 2020, through the date of the first attestation. Subsequent attestations are due annually by December 31 for contracts entered into from the date of the last attestation.

With a fully insured plan, an insurer can agree to submit the required attestation on behalf of the plan. A self-insured or partially self-insured plan may satisfy the attestation requirement by entering into a written agreement under which the plan’s service provider(s), such as a TPA, will submit the attestation for the plan; however, the plan remains responsible for compliance. Accordingly, employers should coordinate the submission of their annual attestation(s) with each carrier or plan service provider to ensure it is timely submitted.

Further information on the gag clause prohibition and attestation requirements is available on the CMS Gag Clause Prohibition Compliance Attestation website. Please also review our September 26, 2023, FAQ and ask your NFP consultant for a copy of our CAA Gag Clause Prohibition and Attestation: A Guide for Employers publication.

The Transparency in Coverage Final Rule (TiC) requires non-grandfathered group health plans and carriers to make personalized out-of-pocket cost information available to participants through an internet-based self-service tool. The purpose of the self-service tool is to provide participants with real-time, accurate estimates of their cost-sharing liability for healthcare items and services from different providers so they can shop and compare healthcare costs. The format may be like an Explanation of Benefits, but the participant receives the information prior to receiving care.

Importantly, the TiC provided phased-in effective dates for the internet self-service tool requirement. For 2023 plan years, 500 “shoppable” items and services were required to be available through the tool. For plan years beginning on or after January 1, 2024, all covered items and services, including prescription drugs and durable medical equipment, must be made available.

As a practical matter, most group health plan sponsors have arranged with their carriers or TPAs to assist with fulfilling these requirements. Fully insured plans can contract with their carrier to assume liability for the tool disclosures. Self-insured plans can contract with TPAs or other vendors but remain responsible for satisfying the requirements. Accordingly, group health plan sponsors should consult with their carriers or TPAs to ensure full implementation of the self-service tool requirement is on schedule.

For further information, please review the Transparency in Coverage Final Rule, Fact Sheet and our prior December 20, 2022, FAQ.

On November 15, 2023, the Employment Department announced the Paid Family and Medical Leave Insurance (Paid Leave Oregon) contribution rates for 2024. The Paid Leave Oregon contribution rate for 2024 is 1% of employee wages up to the federal Social Security taxable wage maximum ($168,600 in 2024). Both employers and employees pay contributions to the Paid Leave Oregon Trust Fund, which are divided between employees and employers, with 60% of the rate paid by employees and 40% by employers.

Oregon Employment Department Announces 2024 Rates for Paid Leave Oregon and Unemployment Insurance »