Public Disclosure of Provider Reimbursement Rates Begins July 1, 2022
On July 1, 2022, enforcement of the machine-readable file requirement of the Transparency in Coverage (TiC) final rule begins. Under the rule, non-grandfathered group health plans and insurers must publicly post machine-readable files that disclose in-network provider negotiated rates and historical out-of-network allowed amounts and billed charges for plan years beginning on or after January 1, 2022. (Enforcement of the prescription drug rate file requirement is postponed pending regulatory review.)
The files must be in a specified format, updated monthly and posted on a public website accessible to any person free of charge. No conditions can be imposed to access the files, such as establishing a user account or password or submitting personally identifiable information.
Group health plan sponsors should be in consultation with their insurers or third-party administrators to ensure timely compliance with the July 1 deadline. For fully insured plans, the legal obligation can be contractually transferred to the insurer. For self-insured plans, the sponsor remains liable for TiC compliance even if a TPA contractually agrees to assist with the creation and implementation of the files.
For further information, please see:
Transparency in Coverage Final Rule »
FAQs on ACA and CAA, 2021 Implementation »
Is an employer’s short-term disability (STD) coverage sufficient to meet the compliance requirements of the various states’ Paid Family and Medical Leave (PFML) programs?
San Francisco Health Care Security Ordinance (HCSO) and Fair Change Ordinance (FCO): Employer Annual Reporting Due May 2, 2022
April 26, 2022
After a two-year break, San Francisco Health Care Security Ordinance employer reporting has resumed this year. Employers who are subject to the San Francisco Health Care Security Ordinance (HCSO) or the Fair Chance Ordinance (FCO) must submit the 2021 Employer Annual Reporting Form by May 2, 2022.
The HCSO applies to employers with 20 or more total employees worldwide and at least one employee who performs work within the city or county of San Francisco. The ordinance requires the employer to meet a certain spending threshold for each San Francisco employee related to health care. Employers must report the number of employees covered by the ordinance per quarter in 2021 and detail the health care expenditures made each quarter (payments for health insurance, contributions to the City Option or irrevocable expenditures to a reimbursement account).
The FCO applies to employers who have five or more total employees worldwide and at least one employee who performs work within the city or county of San Francisco. Additionally, employers who have a service contract with the City of San Francisco are also subject to the ordinance, regardless of the number of employees. The FCO ordinance prohibits employers from asking about arrest or conviction records on a job application. Employers must report whether their employment application in San Francisco asks about arrest or conviction information; and whether they conducted background checks on conviction or arrest records before a live interview (including telephonic).
Failure to comply with the annual reporting may result in a penalty of $500 per quarter assessed against the employer.
Covered employers should ensure that they retain supporting records to establish compliance with the spending requirements and FCO requirements. For 2022 compliance, covered employers should ensure that they displayed the posters for the 2022 HCSO Notice and FCO Poster in their workplaces or job site. Covered employers should also contribute the 2022 minimum healthcare expenditures for the San Francisco employees and satisfy all other requirements under those ordinances during 2022.
Reporting Form »
Reporting Instructions »
San Francisco HCSO Main Site »
Maryland Enacted Mandatory Paid Family and Medical Leave Program
April 26, 2022
On April 9, 2022, Maryland enacted its statutory Family and Medical Leave Insurance (FAMLI) program by the state legislature overriding Gov. Hogan’s veto. The FAMLI program is also known as the “Time to Care Act of 2022” (Senate Bill 275) and applies to employers who have at least one employee working in Maryland. The payroll withholding of the employees’ contributions is scheduled to begin on October 1, 2023, and the benefits will be available to eligible employees starting January 1, 2025.
Below are the key highlights of FAMLI:
- June 1, 2023: Maryland Secretary of Labor will set the contribution rates
- October 1, 2023: Contributions to the FAMLI program begin
- January 1, 2025: Benefits will be available to employees
An employer who employs at least one employee working in Maryland.
Funding of the Program
Beginning October 1, 2023, employees and employers with 15 or more EEs are required to contribute to the state’s Family Medical Leave Insurance (FAMLI) fund. (The Maryland Secretary of Labor will determine the rates by June 1, 2023.)
Eligibility to Take Leave
Employees who have worked at least 680 hours over the 12-month period in Maryland immediately preceding the date on which leave is to begin.
Qualified Reasons for Leave
Employees’ own serious health condition and for an eligible employee to:
- Care for a family member with a serious health condition
- Bond with a new child (by birth, adoption or fostering) during the first 12 months after the child’s birth or placement
- Care for a next-of-kin service member
- Attend to a qualifying exigency arising out of a family member’s military deployment.
Maximum Benefits Duration
- 12 weeks within the 12-month period following the employee applying for benefits.
- An additional 12 weeks (i.e., total 24 weeks) is provided if the employee received benefits for childcare during the first year of a new child’s birth or adoption and then becomes eligible for benefits due to the employee’s serious health condition (or vice versa).
- Leave can be taken continuously or intermittently (a minimum increment of 4 hours).
Maximum Benefits Amount
Based on each employee’s average weekly wage ranges from $50 to $1,000 cap per week, then indexed to inflation from the subsequent years.
Notice to Employees
Employers must provide written notice to each covered employee to inform them of the employee’s rights and duties under the FAMLI program when an employee is hired and annually thereafter. Additionally, employers must provide the notice when an employee requests FAMLI leave. The Maryland Department of Labor will develop standard notices for employers to use in the future.
Employers who have at least one employee in Maryland should be aware of this new update.
State Begins Program Reducing Premiums for Small Business Health Insurance Plans
April 26, 2022
Oregon Announces End to COVID-19 as a Public Health Emergency
April 26, 2022
Oregon Gov. Kate Brown announced recently that the state’s public health emergency proclamation for COVID-19 would end effective April 1, 2022. Gov. Brown initially extended the current declaration of a public health emergency through June 30, 2022. However, due to the decline in the COVID-19 numbers, Gov. Brown declared the public health emergency would end on April 1, 2022, more than two years after it was first announced. The ending of Oregon’s public health emergency also ended COVID-19 leave benefits in the state.
Employers with employees in Oregon should be aware of the changes.
Extended Relief for Non-ACA-Compliant Small Group and Individual Policies and Plans
April 26, 2022
On April 15, 2022, Commissioner Houdek released a bulletin that extended the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans indefinitely until such time as CMS issues an announcement ending the non-enforcement of certain market reforms.
On March 23, 2022, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, if the state allows for such an extension. Such transition policies are not required to comply with certain ACA mandates, including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Wisconsin and allows the issuer to renew these non-ACA-compliant plans.
Small employers interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.
Bulletin, April 15, 2022, Extension of Transitional Health Insurance Plans »
This material was created by PPI Benefit Solutions to provide accurate and reliable information on the subjects covered but should not be regarded as a complete analysis of these subjects. It is not intended to provide specific legal, tax or other professional advice. The service of an appropriate professional should be sought regarding your individual situation. PPI does not offer tax or legal advice. "PPI®" is a service mark of Professional Pensions, Inc., a subsidiary of NFP Corp. (NFP). All rights reserved.