Consolidated Appropriations Act of 2021 and Transparency in Coverage Rule: What you need to know (FAQs)

The Consolidated Appropriations Act of 2021 (CAA) and the Transparency in Coverage Rule (TIC Rule) both contain numerous health care provisions establishing new standards for price transparency and patient protections against certain surprise medical bills. These two pieces of legislation have the potential to fundamentally transform the way consumers shop for health care services, empowering them to make more well-informed purchase decisions. While many of the details are yet to be finalized through rulemaking, we’re monitoring developments closely and will provide more information when it’s available.

Following is an overview of the key provisions of the CAA and TIC Rule, and frequently asked questions about steps we’re taking to ensure our plans and groups meet compliance requirements. Provisions apply to both fully insured and self-funded groups and individuals unless otherwise noted. For answers to general questions about the CAA and TIC Rule see below.

Frequently Asked Questions

General CAA FAQ
 How is Regence coordinating to implement the CAA requirements?

Regence is implementing CAA requirements via multiple work streams. Due to the complexity and breadth of requirements, work streams are being driven at the enterprise level. We will continue to provide updates on each individual workstream and our collective progress as the information becomes available.

 How and when will updates on our compliance with the various CAA requirements be communicated to clients?

Regence will provide appropriately timed updates to brokers, employers and members through our regular communications channels as final CAA rules are issued: Producer News (monthly), Employer News (quarterly) and Member News (monthly). We will also create a standing CAA compliance web page with updated FAQs on regence.com.

 Will Regence comply with the new requirements prohibiting group health plans from entering into a services agreement that, directly or indirectly, restricts the group health plan from disclosing provider-specific costs, quality of care information, or electronically accessing de-identified claims data?

Yes. We confirm we are prepared to comply with this requirement.

 How will the CAA requirements impact contracts with plan sponsors?

We are evaluating any impacts for contracts with plan sponsors and will work with plan sponsors to incorporate contract changes, when necessary.

 How will the CAA requirements impact fully insured rates?

Fully insured rates for 2022 are filed and approved. We will evaluate long-term costs associated with these new requirements, and will adjust rates in future years, as needed.

 Will any contract amendments be needed to existing client contracts or NDAs to enable Regence to support and comply with CAA requirements?

Regence does not believe our contract language interferes in the ability of our clients to comply with CAA’s disclosure requirements. We will work with groups directly on any contractual language concerns.

 Are any plans or reimbursement accounts exempt from the CAA?

The following plans and reimbursement accounts are exempt from the rule:

  • Excepted benefits (e.g. standalone vision, dental, and hearing plans), when not integrated with an applicable medical plan
  • Retiree only plans
  • Short term limited duration (STLD) plans
  • Medicare plans
  • Medicaid plans
  • Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSA)
General TIC FAQ
 When does the TIC Rule take effect?

For plan years beginning on and after July 1, 2022, insurers and plans must make available to the public, among other data, negotiated prices and historical net plan allowable amounts for all covered items and services, including prescription drugs.

For plan years beginning on and after January 1, 2023, insurers and plans must provide members with benefit cost estimator tools that enable members to understand and compare their personalized out-of-pocket costs for covered in-network (INN) and out-of-network (OON) services in real-time. The tool must contain prices on the 500 items, services, and prescriptions drugs identified in the final rule. The list contains primarily medical items and services for January 1, 2023. Beginning with plan years starting on and after January 1, 2024, the list will be expanded to contain all covered medical items, services and drugs, enabling members and consumers to understand and compare their personalized out-of-pocket costs for all INN and OON services in real-time.

 Who must comply with the rule?

The rule applies to health insurers in the group and individual markets, and group health plans. Health insurers are responsible for implementing the requirements for fully insured group and individual health plans. Self-funded group health plans may contract with third-party administrators to implement some or all requirements of the rule. The rule also applies to exchange plans and Transitional Relief plans (sometimes called “grandmother” coverage) plans.

 Are any plans or reimbursement accounts exempt from the rule?

The following plans and reimbursement accounts are exempt from the rule:

  • Legacy (sometimes called “grandfathered”) plans
  • Excepted benefits (e.g. standalone vision, dental, and hearing plans), when not integrated with an applicable medical plan
  • Retiree only plans
  • Short term limited duration (STLD) plans
  • Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSA)
  • Medicare plans
  • Medicaid plans

Legacy plans in place prior to enactment of the Affordable Care Act (ACA), are exempt from the rule, as well as many ACA requirements, provided no significant changes are made to the plan design. Health plans are required to disclose whether they consider themselves a legacy plan. Transitional Relief plans became effective after the ACA enactment and do not comply with certain ACA provisions. Federal regulators have allowed these plans to renew under a nonenforcement policy on an annual basis if the plans are otherwise permitted by state law. Customers should consult their own counsel on whether a plan is not covered. When integrated with an applicable medical plan, excepted benefits such as standalone dental or vision coverage are subject to the rule.

 Are non-ERISA self-funded plans included in the rule?

Non-ERISA self-funded plans are impacted and must meet both the machine-readable file (MRF) and price comparison tool requirements. Clients should consult their legal counsel for additional guidance.

 Are tribal plans included in the rule?

Tribal health plans that are organized under ERISA or the Public Health Services Act (PHSA), are subject to transparency requirements. Clients should consult their legal counsel for additional guidance.

 Can insurers support the compliance requirements for a self-funded plan?

Yes. An insurer or third-party administrator (TPA) may support the compliance requirements for a self-funded group health plan.

 Does the rule comply with all HIPAA and other security and privacy rules?

Yes. The rule did not alter existing state and federal privacy or security requirements, including the Health Insurance Portability and Accountability Act (HIPAA). The transparency final rule does not require the public disclosure of any protected personal health information (PHI).

 How will the rule be enforced?

States will have primary enforcement authority, with HHS being responsible for enforcement if a state fails to do so. Group health plans subject to ERISA are subject to enforcement by the DOL.

Mental health

Mental health parity - non-quantitative treatment limit (NQTL) testing (CAA)

Effective date (compliance deadline): February 10, 2021

What it is: Insurers are required to conduct analyses of non-quantitative treatment limitations (NQTLs) for compliance with Mental Health Parity requirements. Upon request, insurers must provide documented analyses to the Tri Agencies (U.S. Depts. Of HHS, Labor and Treasury) for review. Regence will ensure compliance for fully insured and Individual plans and can assist ASO groups’ efforts to document compliance.

 When do the new Mental Health Parity (MHP) Non-Quantitative Treatment Limit (NQTL) requirements take effect?

As of February 2021, groups and insurers are required to provide NQTL analyses when requested by federal regulators. We continue to monitor for instances in which NQTL audits are conducted, and will incorporate additional information into our existing processes.

 What is required in relation to MHP under the CAA?

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPEA) has been effect since 2010 and health plans have been required to ensure parity with Non-Quantitative Treatment Limit for many years. Additionally, subsequent regulations have required health plans to provide certain disclosures including processes, strategies, evidentiary standard, and other factors used to apply NQTLs.

The CAA added an additional disclosure requirement that includes a comparative analysis that addresses the specific plan or coverage terms relevant to the NQTL; the factors and evidentiary standards used to determine the NQTL; a comparative analysis of the NQTL; and the specific findings and conclusions of the analysis. In further guidance, the Tri-Agencies stated that the “Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA)” provided by the US Department of Labor (DOL), which contains a six-step analysis for health plan NQTLs will meet the disclosure requirements of the CAA.

 Does Regence provide a comprehensive comparative analysis disclosure, as required under the CAA?

In compliance with the requirements of the CAA, Regence has developed the “Mental Health Parity and Addition Equity Act Non-Quantitative Treatment Analysis Disclosure” booklet. The information provided in the booklet and the format used are modeled after the “Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA)” provided by the US Department of Labor (DOL), which the DOL as stated in subsequent guidance meets the requirements of the health plan disclosure requirements within CAA.

The purpose of the booklet is to demonstrate the compliance of Regence standard plans with MHPAEA by analyzing each plan NQTL using the six-step analysis developed by the US Department of Labor through the Self-Compliance Tool.
Please note that Regence will update the booklet, along with other documents referenced within as process, procedures and regulatory requirements are updated and clarified.

Regence will provide specific supporting documentation referenced in the booklet upon request, and when formally requested by a member, provider, or regulator as part of an audit, in compliance with the CAA.

 Will Regence provide comprehensive comparative analyses of our self-funded health plans’ compliance with MHP NQTLs?

The NQTL analysis Regence has conducted is based on Regence standard fully insured plans, and applies to all Regence commercial lines of business, across all states in which Regence issues insured health plans.

For self-funded plans, plan sponsors are responsible for ensuring their plans are compliant with any applicable state and federal laws. Accordingly, the Regence “Mental Health Parity and Addition Equity Act Non-Quantitative Treatment Analysis Disclosure” is for informational purposes only in connection with self-funded plans administered by Regence. As such, self-funded plans may need to perform additional analyses, particularly for customized plans.

Regence will provide specific supporting documentation referenced in the booklet upon request, and when formally requested by a member, provider, or regulator as part of an audit, in compliance with the CAA. If a state or federal regulator initiates a MHPAEA audit of an employer group client, Regence will work in partnership with the client to provide appropriate and up-to-date documentation in relation to the services Regence provides in support of the audit.

 Can I share the Regence “Mental Health Parity and Addition Equity Act Non-Quantitative Treatment Analysis Disclosure” with my broker?

The booklet is confidential and contains Regence’s Proprietary Materials. All information contained in the booklet is subject to the applicable provisions contained within any contract between the rightful recipient and Regence. Therefore, group clients will need to abide by any confidential information requirements contained in their contract with Regence. The booklet is considered a regulatory document subject to confidentiality contract provisions and not marketing material, therefore it should not be dispersed as such.

Surprise billing

Surprise billing protections: Federal balance billing law (No Surprises Act - CAA)

Effective date (compliance deadline): January 1, 2022

What it is: Insurers will be required to pay claims for emergency services at in-network (INN) rates without regard to network status of provider/facility. Prohibits balance billing for services provided by out-of-network (OON) providers at INN facilities. Requires insurers to use “qualifying payment amounts” as initial reimbursement offer for OON providers. Establishes independent dispute resolution (IDR) process to be used when insurers and OON providers do not agree on a reimbursement amount. Provides nationwide standards for surprise billing protections and in some cases overlaps with states’ surprise billing protections.

 When does the federal balance billing law go into effect?

The federal balance billing law goes into effect at the beginning of plan/policy years on or after January 1, 2022, so the law is in effect for new groups with January 1, 2022 effective dates, and upon renewal for groups that renew on or after January 1, 2022. If a group has yet to renew in 2022, the balance billing protections are not in effect for that group until their renewal date.

 Are groups with off-year renewals (e.g. renewal dates are different from the plan year) subject to NSA at renewal or based on plan year?

We are applying the NSA at the ERISA plan year instead of the group’s renewal date. The law requires it to be applied at plan year. For groups that renew mid-year, the NSA would have started for them on 1/1/2022. If they have a 4/1 plan year, the NSA doesn’t apply until then.

 What plans will the federal balance billing rule impact?

Fully insured plans, self-insured plans, and the Federal Employee Plan. The federal mandate will also apply to legacy plans. The plans excluded from the federal mandate include Medicare Supplement (MediGap) and Medicare Advantage plans. Dental and vision plans are also excluded.

 Can a retiree group opt into the federal balance billing rule?

No, the No Surprises Act does not apply to retiree-only plans.

 What changes have been made in the member benefit booklets to explain the federal balance billing law?

The notice of member rights titled “Your Rights and Protections Against Surprise Medical Bills” has been added to the 2022 member benefit booklets. This provides a high-level overview of the protections and definitions associated with federal balance billing.

 Is the Notice of Member Rights posted on our public website?

Yes, as of 1/1/22. It’s also included with every EOB. We are also working to implement a solution whereby the notice will be included only with applicable EOBs, i.e. those that are subject to balance billing protections.

 Will Regence offer services to support balance billing protections?

Yes, we will provide support to reimburse OON providers and facilities when balance billing is prohibited.

 Which entities will fulfill the role of Independent Dispute Resolution (IDR)? Is this different from the entity currently contracted to negotiate disputed claims?

As we are reviewing the recently released No Surprises Act interim final rule, we continue to develop our approach to administering the IDR process. We have done outreach to the identified Certified Independent Dispute Resolution Entities (CIDREs) and will provide more information on this topic soon.

 How will the IDR process be handled – internally or externally?

We are in the process of evaluating a decision on whether to perform this function in-house or through a third-party vendor.

 How is Regence applying No Surprises Act (NSA) protections as groups renew in 2022?

We have identified the Regence groups and their expected 2022 renewal dates and have configured them into our claims workflows. Once a group reaches the beginning of their ERISA plan year, they will begin to receive their balance billing benefit. We are monitoring claims to ensure they are correctly processing claims eligible for NSA protections. For example, a claim with a date of service prior to the group’s 2022 ERISA plan year would not be flagged as NSA-eligible, and therefore would be processed without NSA protections.

 What steps is Regence taking to ensure NSA claims are being processed correctly?

A Regence cross-functional team reviews claims activity on a daily basis and works through questions and issues in real time. Additionally, we are working to implement claims status reporting for Regence leadership to ensure these requirements receive ongoing focus.

 Are there any circumstances under which we’re holding or pending claims while subject to IDR review?

In some circumstances we may be pending claims for short periods of time.

 Will provider reimbursement disputes over qualified payment amounts, balance billing, Federal IDR, etc. result in claim adjustment or voucher checks?

We will issue claim adjustments, not vouchers.

 Are there any differences between the Oregon balance billing law and the federal balance billing law?

Yes. The federal and Oregon laws differ in the following ways:

Emergency Services

  • Oregon law only applied to emergency services provided at an in-network facility. Federal law requires carriers to cover services in an emergency department of a hospital or freestanding emergency facility, whether in- or out-of-network.
  • Federal law requires carriers to cover services in an emergency department of a hospital, regardless of any plan exclusions that exist (Ex., dependent maternity).
  • The federal law also applies to post stabilization services with respect to the visit in which the emergency room services are furnished. This may include any additional items and services that are covered under a plan and furnished by a non-participating provider/facility after the patient is stabilized and as part of an outpatient observation or inpatient/outpatient regardless of where the services are provided in the hospital.

Out-of-Network Services performed at In-Network Facilities

  • The federal law also requires coverage for services performed at the following in-network facilities when performed by an out-of-network provider: hospital emergency rooms, inpatient and outpatient hospitals, critical access hospitals, inpatient psychiatric and rehabilitation facilities, ambulatory surgical centers, and independent freestanding facilities, as long as they are able to provide emergency services. The Oregon law also includes birthing centers and renal dialysis centers.
  • Both the Oregon law and the Federal law allow providers to have a patient sign a waiver so they can balance bill their patient; however, the federal law does not allow specific providers to acquire the waiver. Those providers include emergency services, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or nonphysician practitioner, and items and services provided by assistant surgeons, hospitalists, and intensivists; diagnostic services (including radiology and laboratory services).

Air Ambulance

  • Federal law requires patients to be held harmless from surprise bills for out-of-network air ambulance services. Oregon rule did not have an air ambulance provision.

Misc.

  • Federal law requires carriers to provide members a notice, “Your Rights and Protections Under Surprise Billing.” This notice will be placed on the Regence website, in most member benefit booklets, and it will also be attached to member EOBs if it reflects services that meet balance billing requirements (ex., emergency services).
  • Oregon’s law did not provide a dispute resolution process for providers who were not satisfied with the payment they received from the carrier. The Federal law does and it will be in effect 1/1/2022 as plans/policies renew (see above). This law applies to providers only; not members.
 Are there any differences between the Washington balance billing law and the federal balance billing law?

Yes. The federal and Washington laws differ in the following ways:

Emergency Services

  • Both Washington and Federal law apply to coverage for services in an emergency department of a hospital or freestanding emergency facility, whether in- or out-of-network.
  • Federal law requires carriers to cover services in an emergency department of a hospital, regardless of any plan exclusions that exist (Ex., dependent maternity).
  • The federal law also applies to post stabilization services with respect to the visit in which the emergency room services are furnished. This may include any additional items and services that are covered under a plan and furnished by a non-participating provider/facility after the patient is stabilized and as part of an outpatient observation or inpatient/outpatient regardless of where the services are provided in the hospital.

Out-of-Network Services performed at In-Network Facilities

  • Both Washington and Federal law applies to coverage for services performed at the following in-network facilities when performed by an out-of-network provider: hospital emergency room, inpatient and outpatient hospital and ambulatory surgical centers. The federal law also includes critical access hospitals, inpatient psychiatric and rehabilitation facilities, and independent freestanding facilities, as long as they are able to provide emergency services.
  • Washington and Federal law require carriers to hold members harmless from balance billing when non-emergency services are provided by out-of-network providers for surgical and ancillary services including, surgery, anesthesiology, pathology, radiology, hospitalists and laboratory. Federal law also included: intensivist, neonatology, whether or not provided by a physician or nonphysician practitioner, and items and services provided by assistant surgeons.

Air Ambulance

  • Federal law requires patients to be held harmless from surprise bills for out-of-network air ambulance services.

Misc.

  • Both Washington and Federal law require carriers to provide members a notice to explain member rights under balance billing. For fully insured and self-funded groups who opted into Washington balance billing, they will receive the Washington notice that will include both Washington and federal language. Self-funded groups will use the federal notice. The notices will be placed on the Regence website and in most member benefit booklets. Although Washington law does not require the notice to be included with member EOBs, the Federal law does; therefore, the plan specific notice (FI or SF) will be attached to member EOBs if it reflects services that meet balance billing requirements (ex., emergency services).
  • Although the federal law allows for a provider to acquire a notice and consent in certain situations, Washington law is prohibiting providers from attaining a notice and consent to balance bill patients. Therefore, if the service and provider are covered under Washington balance billing protections, a provider is not able to ask the patient for consent in those situations.
  • Both the Washington and federal laws have a provider dispute resolution process. Washington has provided guidance their law will supersede the federal law.
 Do Idaho or Utah have balance billing laws?

Neither of these states have balance billing laws so beginning in 2022 individuals and groups in Idaho and Utah will now have federal balance billing protections. Balance billing is not allowed in Idaho and Utah for the following:

Emergency Services

  • Federal law requires carriers to cover services in an emergency department of a hospital or freestanding emergency facility, whether in- or out-of-network.
  • Federal law requires carriers to cover services in an emergency department of a hospital, regardless of any plan exclusions that exist (Ex., dependent maternity).
  • The federal law also applies to post stabilization services with respect to the visit in which the emergency room services are furnished. This may include any additional items and services that are covered under a plan and furnished by a non-participating provider/facility after the patient is stabilized and as part of an outpatient observation or inpatient/outpatient regardless of where the services are provided in the hospital. Specific provider types may acquire a notice and consent once the member has been stabilized, which will allow the provider to balance bill the member.

Out-of-Network Services performed at In-Network Facilities

  • Federal law applies to coverage for services performed at the following in-network facilities when performed by an out-of-network provider: inpatient and outpatient hospital, and ambulatory surgical centers. The federal law also includes critical access hospitals, inpatient psychiatric and rehabilitation facilities, and independent freestanding facilities, as long as they are able to provide emergency services.
  • The federal law allow providers to have a patient sign a waiver so they can balance bill their patient; however, the federal law does not allow specific providers to acquire the waiver. Those providers include emergency services, anesthesiology, pathology, radiology, and neonatology, whether or not provided by a physician or nonphysician practitioner, and items and services provided by assistant surgeons, hospitalists, intensivists, and diagnostic services (including radiology and laboratory services).

Air Ambulance

  • Federal law requires patients to be held harmless from surprise bills for out-of-network air ambulance services.

Misc.

  • Federal law requires carriers to provide members a notice, “Your Rights and Protections Under Surprise Billing.” This notice will be placed on the Regence website, in most member benefit booklets, and it will also be attached to member EOBs if it reflects services that meet balance billing requirements (ex., emergency services).
  • Federal law provides a dispute resolution process for providers who are not satisfied with the payment they received from the carrier. This law applies to providers only; not members.
 If a self-funded group is opted-into Washington or Oregon state balance billing laws, can they opt-out or stay opted in?

It is recommended that self-funded groups who opted-into a state law opt-out. The federal law provides the same protections as the state law specific to emergency services and ancillary services provided by an out-of-network provider at an in-network facility. However, the federal law provides additional provisions, such as post stabilization and air ambulance.

If the self-funded group remains opted into the state balance billing law, it can create member and provider confusion. This can occur because of the overlap between the state and federal laws. Members may not be aware of what law applies for the particular services they receive. For example: A member visits a Washington out-of-network emergency room (state law applies) and is then admitted to the hospital for stabilization services (federal law applies). When the hospital files the claim with the carrier, the payment to the hospital will contain two reimbursement rates: the commercially reasonable rate for the emergency services (state law) and qualified payment amount for the stabilization services (federal law). If the out-of-network hospital wants to dispute the rate paid, they would have to file two disputes – one with the OIC for the emergency services and one with CMS for the stabilization services.

This also creates more complex processes for Regence as the claims system will need to be configured to identify whether the self-funded group is opted-in or -out of the state balance billing law. In the example above, the carrier’s claims processing system will need to determine which rate applies to the various line items contained on the hospital claim, the state’s commercially reasonable rate or the qualified payment amount.

Provider directory

Provider directory - frequency of updates, provider attestation and patient protection for use of incorrect directory data (CAA)

Effective date (compliance deadline): January 1, 2022

What it is: Individual and group health plans must maintain an up-to-date directory of all in-network (INN) providers and facilities for each network and plan. Directory information, including providers’ INN status, addresses, electronic contact info, etc., must be verified every 90 days. Providers will be required to attest to the accuracy of their info; when providers fail to attest to the accuracy of their information, health plans and issuers are required to remove them from their directory (the provider could still be part of a plan/issuer network, but their information won’t be seen in the directory).  Members who inadvertently use incorrect/outdated provider information found in a plan/issuer provider directory can only be charged INN cost shares for treatment received.

Verification of changes to a provider’s information will be required – likely within two business days. We will use Availity (Provider Portal tool) for this. Plans/issuers will be required to respond to provider network questions from members within one business day (two-year communication retention).

HHS plans to publish additional provider directory rules after the January, 2022 compliance deadline, but good-faith compliance is required. This includes limiting cost-sharing to INN amounts when members receive care from out-of-network providers due to inaccurate provider directory information.

 Will Regence allow certain participants to receive up to 90 days of continued coverage at INN rates when their provider moves out-of-network (OON)?

We will administer continuity of care, as required, if a contracted provider leaves our network.

 What will the process be for notifying members about a provider going OON?

As a provider signals intent to leave our provider network, we identify patients of that provider on the basis of claims, and provide notice to impacted members of their provider’s changing network status, as well as their right to continue care with that provider.

 Will Regence administer transitional care, treating an OON provider as INN for an additional 90 days upon request by a member?

Yes, we will administer transitional care.

 Will Regence honor INN cost sharing in certain circumstances when members use incorrect information about a provider’s network status?

Yes. We currently provide access to provider directories on our websites, and will continue to do so. We understand the requirement to honor in-network cost sharing if a member receives from Regence incorrect information about their provider's network status. We will ensure in-network cost sharing is honored for any members in accordance with applicable laws and regulations.

 Does Regence or its ASO groups own responsibility if we fail to comply with the CAA provider directory requirements?

ASO groups have the compliance obligation under the CAA. Regence assumes responsibility for administering the provider directory requirements to the extent that it relates to providing an accurate and comprehensive directory of providers in the Regence network. Regence is not responsible for administering the provider directory requirements in connection with providers outside of the Regence network, including when an ASO carves out PBM and non-network providers.

Member ID cards

Member ID card content changes (CAA)

Effective date (compliance deadline): January 1, 2022

What it is: Cost-sharing information – deductibles and out-of-pocket maximums – for all in-network (INN) and out-of-network (OON) items and services must be printed on member ID cards upon renewal beginning January 1, 2022. Cost sharing information must be included for all covered services purchased through the member’s health plan, including medical, and dental, vision and Rx, that apply for each member. To comply with this requirement, we will be issuing new member ID cards to all Individual and group members, not just subscribers; this includes both new and renewing groups upon renewal beginning 1/1/2022.

 What date does Regence need renewal decisions in order to produce new member ID cards?

Although the member ID cards will be new, our process for producing and issuing them on or before their effective date isn’t changing, and our standard renewal deadlines aren’t changing.

 Will there be any added administrative fees for issuing new member ID cards?

The administrative fees for 2022 have already been finalized and there will be no additional fees added.

 When are the new ID cards required to be distributed to group members?

New member ID cards are required to be distributed to new and renewing group members beginning with January 1, 2022 effective dates.

 When will new ID cards be issued to groups whose ERISA plan years are different from their plan effective dates?

New member ID cards will be reissued in connection with the group’s renewal date (or ERISA plan year start date, if different than renewal date) in 2022.

Machine-Readable Files

Price transparency: Machine-Readable Files (TIC Rule)

Effective date (compliance deadline): Upon renewal for plans beginning July 1, 2022

What it is: Health insurers and group health plans will be required to post publicly available machine-readable files (MRFs) that include in-network (INN) negotiated payment rates based on every provider agreement in force, including INN and extended networks (such as the Blues network) for each group and plan/network offering; and historical out-of-network (OON) reimbursement rates per contract for covered items and services, including prescriptions drugs. The MRF data must be updated monthly and made publicly available to members, all consumers, researchers, employers and third-party developers.

 How and where can the public access the MRFs?

Users will be able to access the MRF query landing page below by clicking on the ‘TIC Machine-Readable Files’ link at the bottom of every public-facing page on regence.com. In addition, groups will be able to copy https://www.regence.com/transparency-in-coverage/ and embed it on their own websites.

 What information is required for someone to access the MRFs?

There is no special information required for someone to access MRFs on https://www.regence.com/transparency-in-coverage/. MRFs for groups can be accessed by clicking on the appropriate line of business link for self-funded or fully insured groups for each state. Clicking each link will produce a combined MRF result that includes all employer group health plans and networks associated with the state and line of business selected.

 How can the public search for a specific group’s MRFs?

MRFs for a specific self-funded or fully insured group of 51+ can be searched on https://www.regence.com/transparency-in-coverage/ typing the group’s Employer Identification Number (EIN) in the search field window and clicking the ‘Get by EIN’ button. Separate MRFs for fully insured small (1-50) groups are not available at the plan level; they are aggregated at the state level and combined with all fully insured groups’ MRFs in each state. Users can access these MRFs by clicking on the fully insured link for their state in the table at the top of https://www.regence.com/transparency-in-coverage/.

 What’s the difference between searching by EIN vs. by state and line of business?

Searching by EIN will produce an MRF that’s specific to the EIN of the self-funded or fully insured 51+ employer group selected. Searching by state and line of business (e.g. self-funded or fully insured) will produce an expanded MRF that includes all the employer group health plans and networks associated with the state and line of business selected.

 What if I can’t find my group’s MRF using their EIN?

MRFs are searchable by EIN only for self-funded groups and fully insured groups of 51+. Fully insured small (1-50) groups’ MRFs are not searchable by EIN; small groups’ MRFs can be accessed by clicking on the fully insured link corresponding to their state.

In addition, some groups’ plans are not covered by the Transparency in Coverage Rule. If a file request by EIN is out of scope, no search results will be shown. Users can consult the CMS rule for details on which plans are within scope.

 Why are MRFs hard to read once they’re downloaded?

Because the MRFs are intended to be used for data aggregation and research purposes, they are required to be generated in a very specific format mandated by CMS. The data in the MRFs will appear like lines of computer code text, and additional coding or other technical support will be required to make them user-friendly for human consumption.

 Do data in the Machine-Readable Files (MRFs) need to match the data on shoppable items and services in the price comparison tool?

No. There is no requirement for the data displayed in the MRFs to correspond directly with data displayed in the price comparison tool. While the MRFs will display in-network (INN) and out-of-network (OON) provider pricing information, the price comparison tool will display each member’s specific cost share.

 What information from secondary networks needs to be included in the INN machine-readable file?

It depends on whether the provider is classified and priced for the plan as INN or OON. If the secondary network providers are considered INN, their rates should be included in the INN file.

 Are dental and/or vision coverage included in the MRF requirement?

Yes. When dental and/or vision are integrated with a customer’s medical plan, they are included.

 When are the MRFs required to be publicly available?

For groups with plan years that begin January 1, 2022 through July 1, 2022, the files were required to be publicly available by July 1, 2022. For groups with plan years beginning August 1, 2022 and thereafter, the files are required to be publicly available before the end of the month of their effective date.

 What are the MRF requirements?

Health insurers and issuers must provide detailed pricing data in two MRFs. The files must be available to users publicly at no cost, and they must be updated each month. Billing codes must be included, enabling the user to identify each item or service, such as:

  • Current Procedural Terminology (CPT) code
  • Health Common Procedure Coding System (HCPCS) code
  • Diagnosis-Related Group (DRG) code or
  • National Drug Code (NDC)
  • Other common identifiers
 What information is required to be included in the MRFs?
  • File One - In-Network Rates. This file must include negotiated rates for all covered INN items and services.
  • File Two - Out-of-Network (Allowed) Historical Rates. File two must include both the billed charges from, and historical payments to, OON providers for all covered items, services, and prescription drugs. If a provider has fewer than 20 claims for a particular item or service during the reporting period, the data for these items and services are not required to be reported.
  • The requirement for a third file containing prescription drug pricing data has been put on hold. This file was to include detailed historical net prices and INN negotiated rates for all covered prescription drugs by plan or issuer at the pharmacy location or other provider level. Additional rules and a new compliance enforcement date pertaining to prescription drug MRFs are expected to be issued in the future.
 How are data required to be displayed?

A standardized format is required for displaying the data. The Centers for Medicare and Medicaid Services (CMS) has issued guidance indicating PDF and Excel documents are not allowable file formats. Because the MRFs are intended to be used for data aggregation and research purposes, they are required to be generated in a very specific format as mandated by CMS. The data in the MRFs will appear like lines of computer code text, and additional coding will be required to make them user-friendly for human consumption.

 Will Regence build and maintain the publicly accessible website with all required MRFs on behalf of employer clients?

It depends on the relationship we have with the client. If we have a contractual relationship with an employer, as with fully insured and self-funded groups who use Regence networks, we will create, generate, and publish MRFs on behalf of customers unless otherwise directed by them. Self-funded groups with custom networks can discuss their specific TIC compliance needs with their AE.

 Will the MRFs be organized by employer group?

Yes. Separate MRFs are required to be created, maintained and updated monthly representing contracted INN and OON pricing for each network. Because the same contracted network pricing often applies to multiple groups, MRFs that contain network rates contracted by more than one employer group will be used for all applicable groups. Note that only medical plans covered under the TIC Rule are included in the MRFs. If a file request by EIN or HIOS-id is out of scope, no search results will be shown. Users can consult the CMS rule for details on which plans are within scope.

 Will Regence charge administrative fees for generating, hosting and maintaining the MRFs mandated in the TIC final rule?

We will waive any fees to customers associated with expenses that we incur for generating, hosting and maintaining MRFs on our website in 2022. This applies to both fully insured and self-funded groups. Any potential administrative fees for maintaining self-funded groups’ MRFs beyond 2022 are to be determined.

 How long will the medical claims history be retained for the MRF? Will it be purged after a certain period of time?

Regence will publish updated MRFs on a monthly basis, replacing the prior month’s file each month. There is no requirement pertaining to retention or displaying of files from prior months.

 Will MRFs contain any member identifiers?

No. The MRFs will have nothing at all to do with member identity. The MRF file for OON items and services will only represent providers’ contracts and allowable amounts; no PHI is included.

 Will we only provide Regence data, or will our MRFs integrate data from other (e.g. PBM, specialty network) vendors?

We are working to ensure that MRFs are available and consistent with the requirements. We are dedicated to working with our employer-sponsored health plan customers to discuss any specific reporting needs.

 How will Regence fulfill requests for MRFs from employer groups and/or third parties?

Because of the large data file size required to transmit all of our provider and Rx pricing data, a business decision has been made to provide MRF data to groups on demand, rather than in real time. When a MRF request is submitted on our publicly-accessible website, our system will generate the requested file at that time. File generation could take considerable time (e.g. up to 24 hours). The requestor will need to make allowances for this time in their request.

 Which data file format (e.g., JSON, XML, YAML, etc.) will be used?

Because the MRFs are intended to be used for data aggregation and research purposes, they are required to be generated in a very specific format as mandated by the Centers for Medicare and Medicaid Services (CMS). We will publish JSON (Javascript Object Notation) files. The data in the MRFs will appear like lines of computer code text, and additional coding will be required to make them user-friendly for human consumption.

 Will Regence provide monthly data updates, and how will Regence keep changes made to the data files up to date?

Files will be updated and available monthly in compliance with the rule. We will follow standard quality and control operations to ensure file and data accuracy as changes are identified. Standard and repeatable processes for file generation will be automated.

 Will Regence comply with the standard file naming convention?

We intend to be compliant.

 Will the versions be dated, so employers will know the updates are current?

Yes, MRFs will continue to reflect the date of the last update.

 When will the data first be publicly accessible?

We intend to comply with the regulatory implementation dates as stated previously: on or before July 1, 2022, MRFs containing costs for all covered services will be accessible.

 How will Regence respond to customers’ questions regarding any missing values such as National Provider Identifier (NPI), procedure codes, etc.?

Customers should follow the standard process and engage their Account Management Team for inquiries.

 Who may use the data and for what purpose?

The MRF data will be publicly accessible by anyone in the public sphere, including members, consumers, researchers, employers and third-party developers. Once made public, Regence cannot control or enforce any restrictions on how the data are used.

 Will we charge customers for creating the MRFs?

We will create MRFs for all fully insured plans. For self-funded customers using a Regence network we will create MRFs as designated under the rule. We will waive any fees to customers associated with expenses that we incur for generating, hosting and maintaining MRFs on our website in 2022. This applies to both fully insured and self-funded groups. Any potential administrative fees for maintaining self-funded groups’ MRFs beyond 2022 are to be determined. Self-funded customers that have plans with custom networks should discuss their compliance needs with their Regence representative. These requests will be considered on a case by case basis. We will report information regarding potential administrative costs as more details become available.

 Is a Regence account required to access the MRFs?

No. The rule requires files to be accessible free of charge to anyone, without requiring to user to have an account or submit any personal contact information.

 How will the impact of value based agreements be represented in MRFs or in the cost comparison experience?

VBA pricing is not required to be included. The pricing that is required will be fee-for-service or bundled arrangements, but will not factor-in the impact of upside/downside risk on pricing.

 How will prescription drug costs be represented in MRFs?

The requirement for generating, hosting and maintaining prescription drug MRFs has been put on hold pending further rulemaking. Previously, covered prescription drugs that are purchased on an INN basis were to be included in the INN Prescription Drug File, and those purchased OON would be included in the OON file. Data for each prescription drug was to include:

  • each drug’s strength, dosage, and formulation level at the first 9-digit NDC level
  • the negotiated cost for each INN pharmacy
  • the pharmacy tax ID number (TIN), place of service code and NPI
  • the issuer’s or health plan’s cost including any allocated price concessions, rebates, discounts, chargebacks, fees.
 How will Regence support customers with a PBM other than Prime?

This is to be determined, since the requirement for prescription drug MRFs is on hold. Customers with PBM networks other than Prime who would like us to post MRFs on their behalf should discuss this with their Regence representative. Requests will be considered on a case by case basis. Information concerning any potential administrative costs associated with posting third party PBM data will be provided to self-funded customers as more details become available.

 Will contracted virtual care providers be included in our MRFs regardless of whether the customer has a direct relationship or not?

Contracted virtual care platforms are network providers, so their rates will be included in the MRFs.

 Will data for clients with custom networks be included in the MRFs?

We will include data for any client specific network for which we pay the claims.

 Will Regence support and maintain out-of-network (OON) MRFs for groups after they term?

Yes. Because OON allowable amounts are based on backward-looking claims data, groups who term with Regence and start with another carrier will need this past data to determine their future OON allowable amounts for a specified time period. We will maintain and provide OON MRFs in these cases for a runout period to be determined on a case by case basis with each group where the situation applies.

Price transparency

Price transparency: price comparison/cost estimator tool (CAA and TIC Rule)

Effective date (compliance deadline): January 1, 2023

What it is: Both the CAA and TIC require group health plans and health insurance issuers to maintain a “price comparison tool” accessible via phone and website that allows enrolled members to compare pricing and cost share amounts for shoppable items and services from any participating provider. The tool must factor in personalized data regarding members’ cost-shares and current benefit accumulator positions, enabling them to obtain good-faith estimates of their out-of-pocket costs for covered medical services and prescription drugs.

Beginning with plan years on or after Jan. 1, 2023, the cost estimator tool must contain pricing information on an initial set of 500 specified shoppable items, services and prescription drugs; for plan years beginning Jan. 1, 2024, the tool must contain all covered items, services and prescription drugs.

Compliance enforcement has been postponed to Jan. 1, 2023 to allow time for reconciling all the price comparison requirements mandated in the Final Rule with the requirements of the CAA price tool, and vis-versa. Our approach, until we receive more detailed rules, will be to expand upon the existing cost comparison tool on Regence.com.

 Will Regence build and manage this price comparison tool on behalf of employer clients?

Yes. We will work to ensure our current cost comparison tool is modified as required to comply with both CAA regulations and TIC rule provisions.

 Will Regence incorporate data from carve-out vendors such as pharmacy benefit managers into your price comparison tools?

We expect to incorporate data from third parties with whom Regence has a contractual relationship. Regence cannot verify the accuracy of data provided by a third party with whom we do not have a contractual arrangement. However, we will work with clients individually to understand the support they require, and try to accommodate.

 What information is required to be included in the price comparison tool?

The tool is required to provide enrollees or their authorized representatives personalized out-of-pocket cost information and underlying negotiated rates for all covered health care items and services, including prescription drugs. The information must be available both online via self-service, and in paper form upon request. Most consumers will be able to get real-time and accurate treatment estimates of their cost-sharing liability from providers. The tool will enable members to understand how costs for covered health care items and services are determined by their plan, and comparison shop estimated health care costs among multiple providers before receiving care.

 When will the cost estimator tool be available?

The tool is required to be available for an initial specified list of 500 shoppable items, services and drugs identified in the rule starting with plan years beginning on or after January 1, 2023. Most of the required services will be medical in the first year. All covered items, services, and drugs are required to be included for plan years beginning on or after January 1, 2024.

 How are all items and services defined?

Beginning January 1, 2024, the cost comparison tool will expand to include all medical care covered by the insurer or plan, including charges for office visits, virtual care, medical tests, durable medical equipment, and prescription drugs.

 What search capabilities will the price comparison tool offer?

Members must be able to search for covered items and services by billing code or descriptive term (e.g., rapid flu test); provider/pharmacy name; and other factors relevant to determine cost sharing (e.g., facility name, service location, network, tiering, dosage). The member will be able to adjust their search or prioritize the results based on geographic proximity of providers and the estimated cost share liability for the item/services/drug if there are multiple results. Information will be available at no cost through an internet self-service tool, and via mail or email sent to a member upon written request.

 What is the purpose of the price comparison tools?

Price comparison tools, and transparency in coverage rules, align with our cause to make health care more person-focused and economically sustainable. The tool will enable consumers to evaluate health care options and to make cost-conscious decisions; reduce potential surprises in relation to members' out-of-pocket costs for health care services; foster competition that may narrow price variability for the same items and services in the same health care markets; and potentially lower overall health care costs. We have provided these types of tools to support members’ efforts to lower their costs for several years.

Cost estimates

Advanced cost estimates and EOBs (CAA)

Effective date (compliance deadline): On hold; previously the compliance deadline was January 1, 2022.

What it is: Payers will be required to provide members an advanced EOB (AEOB) in electronic or paper format as requested by the member, at least three days before a scheduled service from a participating provider/facility. Providers will have to inform payers when services are scheduled and send the payer a cost schedule of billable amounts for all providers involved in performing the service. Cost schedules can be simple or complex, depending on the procedure.

We are anticipating using Availity for our cost schedules, and we will package the info and deliver an AEOB to the member in the requested format (electronic or paper). It is to be determined whether providers will be required to notify us of all scheduled services, or only when requested by a member.

 How are we preparing to respond to the Advanced EOB provision?

The Advanced EOB (AEOB) requirement is on hold pending new rules on standards for data transfers for providers’ good-faith estimates (on which Advanced EOBs are to be based) among other matters. HHS will investigate whether interim solutions are feasible.

We can currently provide single-claim estimates. Prior to enforcement of the provision being postponed, we were working to address multi-claim estimates. We’re engaging Availity as the pipeline to work with providers to send that information to us. Complex procedures involving multiple providers under a single treatment episode will require the scheduling provider to amass and send all of the information to us. And we’re working with our digital team to create a process for members to request the same thing.

 Will Regence share data with third parties to enable them to produce Advance EOBs?

We will assess this on a case-by-case basis. We will support clients who wish to work with third parties to publish their data by providing the data in the required formats. We will evaluate individually if the client wants us to publish third-party data included with data we possess.

 Will Regence incorporate data from carve-out vendors such as pharmacy benefit managers into advance EOBs?

We expect to incorporate data from third parties with whom Regence has a contractual arrangement. For third parties with whom we do not have a contractual arrangement, we cannot verify the accuracy of the information supplied by the third party. However, we will work with clients individually to determine what support they require, and we will try to accommodate.

 How will programs that use coupons, foundations or other alternative funding be reflected in the AEOB?

We are evaluating this question as part of our ongoing solution development work.

Agent/brokers

Agent/broker compensation disclosures (CAA)

Effective date (compliance deadline): January 1, 2022

What it is: Producers will be required to disclose all direct and indirect compensation to group plan sponsors. Insurers will be required to disclose to Individual and Short-Term Limited Duration (STLD) plan applicants and enrollees all direct and indirect producer compensation associated with the applicant’s plan selection. Insurers must disclose annually to HHS all direct and indirect producer compensation in Individual and STLD markets.

 For which lines of business are brokers’ commissions required to be disclosed?

This rule impacts group, Individual and Short-Term Limited Duration (STLD) plans. On the group side, brokers will be required to disclose commissions to group plan sponsors. On the Individual and STLD side, we will be required to disclose brokers’ commissions on Individual and Short-Term Limited Duration plans to Individual customers.

 How will we disclose brokers’ commissions?

We will post brokers’ Individual and STLD commission schedules on a public-facing web page on regence.com for plan applicants’ review both pre-sale and post-sale. Dental commissions will be included. Schedules will include commissions both in PMPM and annualized format.

Pharmacy

Prescription Drug Data Collection (RxDC) reporting

Effective date (compliance deadline): December 27, 2022

What it is: Insurers will be required to report annually to CMS the top drivers of prescription drug costs. Data elements to be reported include: top fifty brand name medications; top fifty medications by total expenditure; top fifty medications by increase in plan expenditure; analysis of health plan expenditure by expenditure type (e.g., primary care versus specialty care). We are awaiting additional rules to specify how data are to be reported.

 What is the purpose of reporting prescription drug and health care spending to CMS?

According to CMS the purpose is to enable better understanding of prescription drug price increases relative to total spending on health care services.

 What kind of prescription drug and health care spending data is required to be reported?

Issuers and sponsors of group health plans are required to report a plan list (P2) and the following eight sets of data (D1-8) to federal agencies annually:

  • D1 premium and life-years
  • D2 spending by category
  • D3 top 50 most frequent brand drugs
  • D4 top 50 most costly drugs
  • D5 top 50 drugs by spending increase
  • D6 prescription drug totals
  • D7 prescription drug rebates by therapeutic class
  • D8 prescription drug rebates for the top 25 drugs

The data must be reported for 2020 and 2021 by Dec. 27, 2022; and by June 30 each year for the preceding calendar year.

 Will Regence manage the required RxDC and health care reporting on behalf of both fully insured and self-funded groups?

Yes. For fully insured groups we will submit reporting on all RxDC required data. There is no action needed by fully insured groups. Self-funded health plan sponsors are responsible to ensure their health plan’s compliance with these new reporting requirements. However, we are permitted to submit reporting for self-funded health plan benefits we administer on behalf of group health plan sponsors. We are offering, with the groups’ permission, to fulfill reporting requirements for the 2020 and 2021 reference years to our self-funded health plan customers at no charge.

Updated guidance issued on Sept. 23, 2022 allows us to submit reporting for groups for whom we only administered a portion of their medical, pharmacy or stoploss benefits in 2020 and 2021. Accordingly, we are offering, with self-funded groups’ permission, to fulfill the reporting requirement for the data we hold on behalf of groups who have a portion of their medical, pharmacy or stoploss benefits administered by another entity.

Where Regence was the sole administrator of all medical and pharmacy benefits, and stop-loss (if applicable), we plan to prepare and submit the P2 and D1-8 data, and narrative response, on behalf of groups. Where we were the sole administrator of a group’s pharmacy benefits with no carve-out, we plan to prepare and submit pharmacy reporting (D3-8), along with the required P2 and narrative response, on the group’s behalf.

Groups participating in joint-administration arrangements should contact their third-party administrator about reporting their data.

Guidance from CMS directs issuers and plan sponsors to aggregate reporting as much as possible.

 How will RxDC reporting be coordinated between Regence and other plan service providers (if applicable)?

Please remember, it is the self-funded groups’ responsibility to ensure their compliance with these new reporting requirements. We will not accept RxDC data or combine data provided by other entities with the data we hold.

To support each group’s reporting, and if directed by the group, we will submit data for benefits that we administered in 2020 and 2021. Where groups had any or all of the following benefits arrangements in 2020 or 2021, we will submit a D1 (premium and life-years) file that represents the benefits that we administered:

  • Carved-out PBM or specialty PBM entity
  • A second (or more) TPA(s) that administered medical benefits or PBM benefits
  • A stop-loss carrier other than or in addition to CBRM/RBSI

The group is responsible for ensuring the remaining data necessary to complete the D1 is reported independently of the data that we submit.

 Why can’t Regence handle the RxDC reporting for all self-funded groups’ needs?

Where we were the sole administrator of a group’s benefits, we plan to prepare and submit the required reporting to the federal agencies. However, where groups have carved out any portion of their medical, pharmacy or stoploss benefits, we cannot prepare and submit the data because we did not administer the benefits and cannot validate its accuracy. We will not accept RxDC data or combine data provided by other entities with the data we hold.

 What information is needed from employer groups so that Regence can perform this reporting?

We are collecting information in order to complete a comprehensive P2 plan document. We are requesting groups sign and return an affirmation of approval for us to prepare and submit RxDC reporting on the benefits that we administered in 2020 and 2021 on their behalf. If we do not receive this signed affirmation, we will send groups the data for their benefits that we administered in 2020 and 2021, along with a link to the reporting instructions on the CMS website.

In addition, we are asking groups’ producers to complete the following plan information on a group-specific data collection sheet and return to us no later than Oct. 31, 2022. Producers are requested to validate that the pre-populated EIN and Form 5500# on each group’s data collection sheet are correct. AEs who know the information about their groups’ carve-outs can complete the data collection sheets themselves rather than requesting that it be done by their producers.

 What information is needed from employer plan sponsors (or their producer or TPA) to submit a D1 report for the 2020 and 2021 reference years and how will Regence collect it? Will this data be due by a certain date?

We intend to submit D1 forms that include only data for benefits we administered in the 2020 and 2021 reference years. There are some data elements we need to confirm with/obtain from the group, and we are in process of distributing a form to collect this information from each group’s producer. This information must be returned no later than October 31, 2022. Please note: for services we did not administer, the group will need to coordinate with its other benefit administrators to gather remaining information to submit a D1 (or confirm submission will be handled on group’s behalf).

 How will Regence collect EE/ER splits for 2022+ reference year submissions?

We are continuing to develop this process and are monitoring for any further regulatory guidance (e.g., FAQs) from CMS.

 Which narrative responses will Regence complete on behalf of your self-funded clients?

We will develop narrative responses applicable to any benefits we administered on behalf of the group. To the extent we are submitting data on behalf of the group, that data will be aggregated with other self-funded group data, and narrative responses will be developed accordingly.

 Will Regence submit narrative responses on behalf of clients, or provide them to clients to the submit themselves?

If the group instructs us to submit data on their behalf, we will submit that data with the associated narrative responses. If the group does not instruct us to submit on their behalf, we will provide the group with their data (in the format required in the data submission instructions), including the associated narrative responses.

 Will Regence automatically prepare and submit the RxDC reporting? Will there be additional costs for plan sponsors?

No and No. We will only prepare and submit reporting on behalf of groups when instructed to do so. Please see answer to the next question below for more details. There are no additional costs for our submitting reporting on behalf of groups for reference years 2020 and 2021.

 Is a written agreement required for Regence to perform the reporting?

Yes. AEs are emailing employer groups an acknowledgement form indicating their approval for us to proceed with RxDC reporting for the benefits that we administered in 2020 and 2021 on their behalf; or send them the aforementioned data for them to submit independently. If we do not receive a group’s signed form by Oct. 31, 2022, we will send them the data for their benefits that we administered in 2020 and 2021 for them to report independently.

 How are we handling 2020-21 reporting for groups who are no longer active?

We will contact inactive groups via email to obtain their preference on the handling of their data. If the group wants us to submit reporting on their behalf we will do so as a courtesy, upon receiving their written permission by Oct. 31. At the group’s preference, we will provide them their data so that they can file it independently or through a TPA. As a reminder, the ultimate compliance responsibility resides with the group.

 Will Regence provide confirmation that RxDC data has been uploaded for clients’ recordkeeping purposes?

Yes. We will provide confirmation to groups and their producers via Employer News and Producer News.