Q4 compliance

Q4 Employer Compliance 2021

The following are important employer compliance items to consider with the 2021 4th quarter coming to an end.   

New Interim Final Rule Issued On “No Surprises Act”

The Departments of Health and Human Services, Labor, and Treasury recently issued a new interim final rule regarding the No Surprises Act provisions of the Consolidated Appropriations Act, which take effect on January 1, 2022. The No Surprises Act protects patients from most surprise bills for out-of-network services and air ambulance providers. 

Provisions of the interim rule include the following protections:

  • Regardless of where they are provided, emergency services must be treated on an in-network basis without requirements for prior authorization.
  • Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if an in-network doctor provided such services. Any co-insurance or deductible must be based on in-network provider rates.
  • Bans out-of-network charges for ancillary care such as for an anesthesiologist or assistant surgeon at an in-network facility in all circumstances.
  • Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

The new interim final rule details the federal arbitration process that providers, facilities, air ambulance services, and health plan issuers will use to determine final payment beyond allowable patient cost-sharing for certain out-of-network healthcare services. For additional details, see the Interim Final Rule.

125 Premium Only Plan & Flexible Spending Account Compliance

Employers who offer a 125 POP or FSA must conduct nondiscrimination testing on the last day of their plan year to ensure that benefits are available to all eligible employees under the same terms. A good practice is to test the plan after open enrollment is complete and again at the end of the plan year. Early testing allows for modifications in plan design should discrimination testing result in a failure. Due date: December 31, 2021 (if on a calendar year plan) 

The Consolidated Appropriations Act of 2021 (CAA) made several changes affecting group health plans, cafeteria plans, and retirement plans, including the $550 carryover for FSA plan participants from 2020 to 2021. Employers who, due to COVID-19, adopted or allowed a carryover option, extended grace periods or employee changes in election or coverage must amend their plans by December 31, 2021. If participants were notified of the change, the amendment may be made retroactive to January 1, 2020.

FSA Newly Covered Medical Expenses. The Coronavirus Aid, Relief, and Economic Security (CARES) Act that was signed into law in 2020 expanded the list of FSA-eligible medical expenses, including the following:

  • Personal Protective Equipment (PPE): face masks, hand sanitizer and sanitizing wipes for the primary use in preventing the spread of COVID-19
  • Over-the-counter drugs, medicines, and menstrual care products (Tylenol, allergy relief, cold medicine, cups, tampons, liners, period underwear, and pads)

The items listed above may be subject to further restriction based on changing regulations. An employer may limit which expenses are allowable under their FSA or HRA plan offering.

ACA Open Enrollment Period Extended and User Fees Increased

The Centers for Medicare and Medicaid Services recently released a new final rule that extends the 2022 Affordable Care Act open enrollment period by 30 days to January 15, 2022, and increased user fees. By 2022, the federally run marketplace user fee rate will increase by one-half percent to 2.75% of premiums. The user fee for state-run exchanges will also increase by one-half percent, to 2.25%.

Mental Health Parity and Addition Equity Act (MHPAEA) 

The deadline for self-insured plan sponsors and insurers to analyze the group medical plan’s for compliance with the Consolidated Appropriations Act of 2021 (CAA 2021) was February 10, 2021. Self-funded plans should confirm with their service provider that the necessary analysis has taken place or complete the analysis using the Department of Labor’s self-compliance tool.

Changes to Group Medical Plans Under the Cares Act and IRS Notice 2020-15

Employers should reach out and confirm with their plan providers, administrators or consultants regarding any plan amendments needed before December 31, 2021, specific to cost-sharing. Preauthorization and other activities and provision for Telemedicine, COVID testing, and vaccination.  

Written by: Sara Jacobs, HR Business Partner                                                     

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