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Department Issued FAQs Clarify How Plan Sponsors With No Public Website Can Comply With Machine Readable File Requirement

On August 19, 2022, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) released another round of FAQs regarding the Affordable Care Act (ACA) and the No Surprises Act of the Consolidated Appropriations Act, 2021(CAA). Two questions (Q22 and Q23) provided additional guidance on the Transparency in Coverage (TiC) rules.

As background, the TiC rules require non-grandfathered group health plans and insurers to disclose on a public website, information regarding in-network rates for covered items and services, and out-of-network allowed amounts and billed charges for covered items and services. Enforcement of the requirements related to public disclosure of the machine-readable file (MRFs) requirement for in-network and out-of-network health care services was originally January 1, 2022, but was deferred to July 1, 2022.

This recent FAQ provides a safe harbor for group health plans that do not have their own public-facing website. Question 22 in the FAQs clarified that a group health plan that does not have a public website does not have to create its own website so that it can provide a link to where the MRFs are publicly available.

Nothing in the TiC rules requires the plan to create its own website for purposes of providing a link. This guidance applies specifically to instances when the plan sponsor (typically the employer) maintains a public website, but the group health plan sponsored by the employer does not.

In previous guidance, and reiterated in this recent guidance, health plans can satisfy their compliance requirements by entering into a written agreement that their service provider (e.g., carrier, TPA, or health care claims clearinghouse) to publicly post the MRFs on its own public website on behalf of the plan. However, self-insured plans still retain liability if the other party fails to post the files, so it is prudent to monitor third-party compliance.

To learn more about the Transparency in Coverage Rule and what it means for eligable employers, read the blog: Departments Issue Transparency in Coverage Final Rule.