Consolidated Appropriations Act
Late 2021, we sent you information about how we at Blue Cross and Blue Shield of Louisiana complied with provisions of the Consolidated Appropriations Act (CAA) that were effective Jan. 1, 2022. You can refer to that message here.
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Transparency in Coverage Rule Overview
The Transparency in Coverage Rule (TCR or TiC) was released Oct. 29, 2020, by the Department of Health and Human Services (HHS), the Department of Labor and the Department of the Treasury and is part of the Consolidated Appropriations Act. The requirements in this rule intend to give consumers increased transparency into health care pricing information through health plans.
The following information explains how Blue Cross intends to comply with these upcoming provisions:
Consolidated Appropriations Act Overview
The Consolidated Appropriations Act (CAA) of 2021 (H.R. 133) contained several requirements for health insurers, as well as self-funded plans maintained under ERISA, that apply to plan years on and after Jan. 1, 2022.
The following information explains how Blue Cross and Blue Shield of Louisiana intends to comply with these upcoming provisions:
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Transparency in Coverage Rule Update:
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Machine-Readable Files
Most health insurance plans, including self-funded groups, will be required to make certain machine-readable reports with detailed network and out-of-network pricing information available on a public website. Blue Cross will post in-network and allowed amount machine-readable files for its fully insured groups as required and self-funded groups for their convenience.
- Beginning July 1, groups will be able to access Blue Cross machine-readable files at bcbsla.com by clicking Transparency in Coverage under Helpful Links. This link will not be live before July 1. Groups can access required files from this public website by entering an Employer Identification Number (EIN) or group plan name. There may be multiple files for a group if it offers multiple plans. The files will be in JavaScript Object Notation (JSON) format as CMS requires and will be updated monthly.
- Because Blue Cross has posted self-funded groups' files on its site, this fulfills the requirement for those groups. Self-funded groups may contact their Blue Cross representative to request a link to their group-specific machine-readable files for use on the group’s website if they wish to do so. When this link is accessed, the group’s Table of Contents file will be returned via forced download. While the files will be updated monthly, the group-specific URL will not change.
Blue Cross is working diligently on this requirement and will publish in-network machine-readable files with available rates on July 1, 2022.
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Self-service Pricing Tool
Most health plans will be required to give members personalized out-of-pocket cost information, and the underlying negotiated rates, for all covered health care items and services, including prescription drugs, through an internet-based, self-service tool and in paper form upon request. Health plans are required to offer this tool for 500 health care services as of Jan. 1, 2023, and all services as of Jan. 1, 2024.
Blue Cross intends to meet this requirement by the required dates.
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Consolidated Appropriations Act Update:
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Advanced Explanation of Benefits
Providers will need to give health plans an advance statement of expected charges for a scheduled service for a member. We will eventually need to provide to members an explanation of benefits in advance for that service before the member has the scheduled service.
This requirement's enforcement date has been delayed. We expect more guidance on this requirement later in 2022.
Price Comparison Tool
Health plans will need to give members a web-based price transparency tool that will show expected costs of certain services provided in the member’s service area. We expect the use of one tool may encompass the requirements of both this provision and the Self-service Pricing Tool provision under the Transparency in Coverage Rule. More on that provision is included later in this message. Health plans are required to offer this service as of Jan. 1, 2023.
Blue Cross intends to meet the required implementation date.
Mental Health Parity
Mental Health Parity ensures that mental health and substance use disorder benefits are given no more limitations than medical/surgical benefits. Health insurance companies and groups must perform and document comparative analyses of the design and application of Nonquantitative Treatment Limitations (NQTLs).
Blue Cross will complete a comparative analysis of our fully insured plans.
Self-funded groups are responsible for ensuring plans are compliant with the Mental Health Parity and Addiction Equity Act. When a group receives a request for a comparative analysis or other inquiry from an applicable regulatory agency, we will assist as follows:
- If Blue Cross handles 100% of the administration for an ASO group and the group has standard benefits, Blue Cross will provide the group information available for NQTLs for standard benefit selections within a reasonable amount of time to aid in the group’s performance of their analysis. Blue Cross may also provide additional information on the benefits administered by Blue Cross if needed and if available.
- If Blue Cross does not handle 100% of the administration for an ASO group and the group does not have standard benefits, Blue Cross will only provide the group the information available for NQTLs for standard benefit selections that Blue Cross administers within a reasonable amount of time to aid in the group’s performance of their analysis. Blue Cross may also provide additional information on the benefits administered by Blue Cross if needed and if available.
We anticipate more guidance on this provision to come.
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Pharmacy Benefits and Drug Costs Reporting
Health insurance companies and groups must report annual data on drug utilization, spending and rebates, including total spending on health care services by type, average monthly premium and impact on premiums by rebates. Blue Cross may have to coordinate required data with self-funded groups that carve out pharmacy benefits.
- Blue Cross will report data on behalf of our individual members fully insured groups and self-funded groups with carved in pharmacy benefits.
- Self-funded groups with pharmacy benefits carved out of their Blue Cross health plans will need to contact their legal representatives or pharmacy benefit managers for more information.
Blue Cross intends to meet the required implementation date of Dec. 27, 2022. Reporting must be done by June 1 of each year going forward.
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Thank you for your patience and cooperation while we work to meet the requirements of these federal regulations.
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Thank you for your business!
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Need more information?
For sales questions:
Contact your Blue Cross representative
For technical AccessBlue questions:
Email us at eBusinessServiceDesk@bcbsla.com or call 1-844-268-3752
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