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- Employers should carefully consider and prepare for the compliance changes and new requirements in 2022, and should monitor future developments.
- In particular, the IRS may begin to more aggressively pursue ACA penalties and taxes against employers if the good faith transitional relief for ACA reporting requirements is officially removed. Additionally, plans should prepare for DOL audits involving NQTL and other requirements under the MHPAEA.
- Plans should consult with ERISA’s counsel regarding these changes. Some new requirements are complicated and may require significant effort to properly implement.
The start of the year is always a good time for plan sponsors to take stock of their benefits offerings and make plan design decisions and plan compliance updates. However, this year presents new challenges. Employers should take note of the new deadlines and requirements that apply to their benefit plans in 2022. The table below provides an overview of compliance issues that are likely to impact health and welfare plans. be in 2022 and that plan sponsors and administrators should review with a lawyer.
New law without surprises/transparency rules in coverage
On December 27, 2020, the law with no surprises was signed into law as part of the Consolidated Appropriations Act of 2021 (CAA). The No Surprises Act institutes certain requirements for health plans and issuers intended to protect against surprise medical bills, increase transparency, and enable patient education, including:
- As of January 1, 2022, providers must not “surprise” the balance of the bill in certain cases when the patient has not provided written consent in certain situations, including when a person requests emergency care outside network or when receiving care from an outside facility. network provider in some network facilities. Instead, in these cases, patients can only be billed the applicable cost-sharing amount in the network, and plans and providers will need to negotiate payment of the balance. In addition, plan sponsors and issuers must inform employees of their rights, disclosing specific information about federal restrictions on balance billing and any applicable state laws. A template notice is available here.
- Also starting January 1, 2022, medical plan ID cards must show deductibles and disbursements, as well as phone numbers and website addresses that patients can use to request assistance.
Enforcement of certain other no-surprises law requirements / transparency-in-coverage rules will be deferred or delayed (according to FAQs published by the Departments of Labour, Health and Human Services and the Treasury (collectively Departments), as well as Interim Final Rules Part I and Part II), including:
- Release certain issuer machine-readable plans and files related to prescription drug pricing (pending development of new rules);
- Post other types of machine-readable files, including those relating to certain on-network and off-network information (until July 1, 2022);
- Provision of a price comparator (until January 1, 2023);
- Provide a good faith estimate of expected health care costs for insured patients submitting a claim (pending the development of new rules); however, still effective January 1, 2022, certain health care providers and facilities must generate good faith estimates for those who are uninsured or who do not submit a claim;
- Provide an advanced explanation of benefit notification in clear, understandable language to certain people (pending the development of new rules); and
- Reporting of pharmacy benefits and drug costs (pending the development of new rules, but with an eye on December 27, 2022 for the reporting of 2020 and 2021 data).
The departments intend to issue future regulations. Until then, plans and issuers must use reasonable and good faith interpretations of the law.
NQTL analysis of parity in mental health
The CAA requires that, beginning in February 2021, group health insurance plans providing mental health and addiction benefits and medical/surgical benefits be able to provide (upon request) benchmarking to the Department of Labor (DOL), to demonstrate compliance with the Non-Quantitative Treatment Limitations (NQTL) requirements of the Mental Health Parity and Substance Abuse Equity Act (MHPAEA). An MHPAEA Self-Compliance Tool is available on the DOL website as a resource for issuers and plan sponsors (Section F of the tool discussing NQTL requirements).
The DOL has actively audited NQTL compliance plans, and a 2022 MHPAEA report to Congress highlights the recent emphasis on greater enforcement of the MHPAEA. Accordingly, plan sponsors should have an ERISA attorney review a completed comparative analysis, ready for submission upon request.
Benefit limits 2022
The Internal Revenue Service (IRS) has released 2022 limits for Qualified Transportation Benefits, Adoption Assistance Programs, Flexible Health Care Spending Accounts (FSA), and Care Premiums. long term. This year’s limits are available here and generally reflect an increase from 2021 limits.
- The FSA limit for dependents has returned to its pre-2021 limit of $2,500 for individuals or $5,000 for married couples filing jointly (i.e. with no effect of the limit special and augmented Congress in place for 2021 only).
- Additionally, the IRS issued guidance increasing the 2022 out-of-pocket limits for high-deductible health plan (HDHP) limits for individuals and families (to $7,050 and $14,100, respectively) and annual health savings account contribution limits (at $3,650 for self-insured). only and $7,300 for family coverage).
- HDHP deductible limits and HRA limits for excluded benefits have not changed for 2022.
Plan for COVID-19 home testing coverage
The departments announced mandatory coverage of the FDA-approved over-the-counter COVID-19 home diagnostic testing plan, effective January 15, 2022. Key takeaways about this home testing coverage mandate can be found in our previous alert.
Broker and Consultant Compensation Disclosure
For contracts or agreements entered into, extended or renewed on or after December 27, 2021, the CAA now requires brokers and consultants to expect to earn $1,000 or more in direct or indirect compensation (related to group health plans of any size subject to ERISA) must disclose such compensation to the plan sponsor reasonably prior to entering into or renewing the triggering agreement or arrangement. The December 30, 2021 DOL Field Support Bulletin details this new disclosure requirement.
Along with this mandate, plan sponsors now have a fiduciary responsibility to report to the DOL any service provider that does not disclose their compensation appropriately.
Extension of the deadline for certain ACA reports
The IRS recently released regulatory proposals targeting certain reporting deadlines for issuers of health coverage, including sponsors of self-funded plans, and applicable large employers (generally those with 50 or more full-time and time-equivalent employees). full) within the scope of patient protection and affordable. Care Act (ACA). In previous years, the IRS had extended the time to provide Forms 1095-B and 1095-C to individuals and employees upon request to the IRS and for cause. This regulation now automatically and definitively extends the 30-day period (until March 2, except in leap years). The separate deadline for vendors and employers to file Forms 1094-B and 1094-C with the IRS generally remains February 28 (or March 31, if electronically filed).
The IRS is removing good faith transitional relief for reporting entities whose ACA forms are incomplete or inaccurate. This means reporting entities must ensure that they submit accurate forms in a timely manner, as the IRS may more aggressively enforce penalties and excise taxes related to incomplete or inaccurate forms.
While the regulations would go into effect for coverage from January 1, 2022, providers and employers can rely on them for reports due for calendar year 2021 (meaning Forms 1095-B and 1095- C must be provided before March 2, 2022).
The content of this article is intended to provide a general guide on the subject. Specialist advice should be sought regarding your particular situation.
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