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Legislative Changes and Regulations: How Custom Design Benefits is Helping You Stay Up to Date Featured Image

Legislative Changes and Regulations: How Custom Design Benefits is Helping You Stay Up to Date

February 10, 2021

Mental Health Parity and Addition Equity Act nonquantitative treatment limitations

  • CDB is prepared to provide data for analysis if your medical plan receives a Department of Labor Request. 
  • On January 1 2023, CDB began offering SupportLinc, an Employee Assistance Program managed by CuraLinc Healthcare, to all plans to ensure access to mental health providers. This benefit can be added at any time – not just at renewal. Please let your Account Manager know if you wish to add this benefit for your employees.

Delayed Enforcement (originally intended for Plan Years on or after January 1, 2022)
Advanced Explanation of Benefits (AEOB)

  • CDB is prepared to work with our vendor partners to produce the AEOB as required by the No Surprises Act in the event the delayed enforcement is rescinded.

January 1, 2022
Ensuring continuity of complex care at in-network benefits for 90 days when provider leaves the network.

  • CDB’s PPO partners continue to provide updates as this occurs to ensure accurate claims processing.

January 1, 2022
Qualified Payment Amounts (QPA) and Independent Dispute Resolution (IDR)

  • CDB has partnered with Payer Compass to determine the QPA rate for out of network claims paid as such when a provider requests an independent dispute resolution. 

Plan Years beginning on or after January 1, 2022 Effective Date
Provider Directories

  • CDB has developed a technology solution for TrueCost members to find an accepting provider and access a price comparison tool – TrueCost Connect.  
  • CDB’s PPO partners are updating their Find a Provider solutions with the price comparison tool. 

December 27, 2022 and ongoing
Pharmacy and Drug Cost Reporting Annual Reporting Requirements

  • CDB is working with our preferred and fully integrated pharmacy benefit managers to provide the required reporting on behalf of plans using a preferred PBM (KPP, MagellanRx and ApproRx).

July 10, 2023
End of National (COVID-19) Emergencies 

  • At the close of business on July 10th, CDB updated all processes and systems to reflect the end of the Outbreak Period and the resumption of the standard deadlines and cost sharing.
  • Plans administered by CDB are in compliance because CDB originally amended your plan with the “Important Updates Regarding COVID-19 Relief – Tolling of Certain Plan Deadlines” language that correlates directly to the Outbreak Period. Therefore, no additional amendment was necessary.

December 31, 2023 – (starting with agreements in effect on December 2020 and each year thereafter)
CAA 2021 Gag Clause Prohibition Compliance Attestation

  • CDB’s partner The Phia Group is reviewing Administrative Service Agreements and Direct Contracts and providing feedback as it pertains to the GCPCA. 
  • CDB will be removing any prohibited language for new contracts.
  • CDB will provide group health plans and their broker partners with the necessary information for reporting, and a link to the instructions and portal for making the attestation.

Delayed until Final Regulations are issued (originally due March 31, 2023)
Air Ambulance Data Collection (AADC)

  • CDB is actively monitoring for the final rules to be issued by the Centers for Medicare & Medicaid Services, and is prepared to work with our vendor partners to provide the required reporting data.

IRS Announces Adjustments to Health Plan Affordability Requirements

The percent of an employee’s household income that’s used to determine an employer’s lowest-premium health plan meets the Affordable Care Act’s (ACA)’s is decreasing next year.

In 2024, the required contribution percentage will be 8.39% of household income – down from 2023’s 9.12%, according to IRS Rev. Proc. 2023-29.

This is the lowest affordability requirement since ACA was implemented. Because the new percentage applies on a plan-year basis, plans will use 9.12% to determine affordability until their new plan years begins (if not at the start of the calendar year).

To evaluate whether your health plan offerings are affordable according to the updated code and corresponding safe harbors, contact your Custom Design Benefits Account Manager.

Medicare Part D Creditable Coverage Disclosure Notices

The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. For these entities, there are two disclosure requirements:

  • A written disclosure notice provided to all Medicare-eligible individuals who are covered under, or eligible for, the prescription drug plan, prior to October 15. Note: Custom Design Benefits will mail the disclosure letter to each member’s home prior to the deadline.
  • Completion of the Online Disclosure to the Centers for Medicare & Medicaid Services Form to report the creditable coverage status of their prescription drug plan. This disclosure should be completed no later than 60 days from the beginning of a plan year, within 30 days after termination of a prescription drug plan or within 30 days after any change in creditable coverage status.

For additional information and guidance documents related to Creditable Coverage requirements for employers, visit the Centers for Medicare & Medicaid Services Creditable Coverage page.

Want more information on compliance matters? Contact your Account Manager to learn more.

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