In the coming months, employers and other group health plan sponsors will need to address a diverse and largely unheralded array of health plan requirements. Collectively, these new rules may constitute the largest set of compliance obligations for health plans since the implementation of the Affordable Care Act. Most of the requirements are set forth in provisions of the Consolidated Appropriations Act, which was signed into law in December 2020, but they also include regulatory guidance published in late 2020 and throughout 2021. The new rules include:
Some of these requirements are already in effect. Others will take effect near the end of 2021 or at the start of the next plan year. The rules require action from those who maintain insured plans as well as those who sponsor self-funded arrangements.*
Employers will not be able to meet these new requirements on their own. They will need the cooperation of their vendors and should be seeking commitments from their insurers, third party administrators, brokers, and others to provide the information and services necessary for compliance. Without this cooperation, health plans could be subject to enforcement actions, monetary penalties, and possible litigation.
The new rules are detailed, and guidance on a number of matters has yet to be issued. However, in a series of separate briefings, we will aim to describe the fundamental requirements of the new rules, one-by-one, and suggest measures that employers may take to bring their plans into compliance. Employers should promptly and carefully consider their own courses of action and seek assistance in complying with the new rules, as appropriate.
Lawyers at Ballard Spahr are working with the new rules and are prepared to assist you with questions that you may have. Please contact Edward Leeds or Brian Pinheiro.
*Certain types of plans—including most dental, vision, employee assistance plans, and individual account plans (such as health flexible spending arrangements and health reimbursement arrangements)—will generally be exempt from the new rules.