On December 31, 2021, the Department of Insurance issued Bulletin No. 2021-09 regarding compliance with the Consolidated Appropriations Act, 2021 (CAA), which includes the No Surprises Act (NSA) and transparency provisions. The stated purpose of the bulletin is to inform insurers, pharmacy benefit managers, independent review organizations and other third-party service providers of the CAA requirements.
The bulletin outlines the NSA surprise billing prohibitions, the independent dispute resolution process and other patient protections. It explains that insurance policy forms must comply with all applicable NSA provisions. Accordingly, forms may require amendments and submission for approval in accordance with the designated process. Further, insurers are required to complete a certification confirming that all policy forms comply with the applicable provisions of the CAA effective January 1, 2022. This certification is provided on the last page of the bulletin. The guidance also references the transparency requirements, including the requirement for insurers to disclose certain compensation arrangements effective December 27, 2021.
The bulletin further explains that enforcement of the CAA provisions generally follows the enforcement provisions of the ACA. In other words, the federal DOL will enforce provisions of the CAA as they relate to self-insured plans, and the states will regulate fully insured plans and other licensees engaged in the issuance or servicing of health insurance coverage.
Although the bulletin is directed at insurers, employers who sponsor fully insured plans should be aware of this guidance.
Bulletin 2021-09 »
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