The Departments of Labor, Health and Human Services and Treasury (The Departments) have released updated FAQs around the requirement for plans and issuers to post machine-readable files on a public website. Per the Consolidated Appropriations Act, 2021 (CAA), plans and issuers were required to post, in three separate machine-readable files, information related to the in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for covered items and services, and negotiated rates and historical net prices for covered prescription drugs. This requirement was applicable to plan years beginning on or after January 1, 2022.
Prior to the effective date of the machine-readable file requirement, the Departments released FAQs announcing the deferral of enforcement regarding certain requirements, which included pushing the enforcement date to July 1, 2022, and a pause on the posting requirement related to prescription drugs pending further rulemaking. This pause was due to a concern of potential conflict and overlap between this regulation and the requirements outlined by the CAA’s RxDC Reporting. The Departments announced in their updated FAQs that after review of the CAA’s RxDC Reporting requirement and machine-readable file requirements, there is no “meaningful conflict” that would warrant the deferral on enforcement. The FAQs state that a “case-by-case” enforcement approach for this posting requirement is more appropriate.
Plans that relied on their carriers or third-party administrators to post the first two files should ensure that the language of such agreements is broad enough to encompass the posting of the prescription drug file as well. If no such language or agreement exists, plan sponsors should work with their carriers to ensure the necessary files are posted or determine if posting on their own behalf would be more appropriate. It appears that the previous guidance stating that a plan without an existing public website does not need to create one to comply with the machine-readable file requirements is still in place; however, additional implementation guidance is expected to be released by the Departments.