Learn more about Medicare Part D Notices Due Date and the New Guidance on Health Care Transparency.
MEDICARE PART D NOTICES DUE BEFORE OCTOBER 15, 2022
Each year, Medicare Part D requires group
health plan sponsors to disclose whether
the health plan’s prescription drug coverage
is creditable to individuals eligible for
Medicare Part D and the Centers for
Medicare and Medicaid Services (CMS).
Plan sponsors must provide the annual
disclosure notice to Medicare-eligible
individuals before Oct. 15, 2022
—the start
date of the annual enrollment period for
Medicare Part D. CMS has provided model
disclosure notices for employers to use.
Medicare beneficiaries who do not have
creditable prescription drug coverage and
do not enroll in Medicare Part D when first
eligible will likely pay higher premiums if
they enroll at a later date. Although no
specific penalties are associated with the
notice requirement, failing to provide the
notice may be detrimental to employees.
Employers should confirm whether their
health plans’ prescription drug coverage is
creditable or noncreditable and prepare to
send their Medicare Part D disclosure
notices before Oct. 15, 2022. To make the
process easier, employers often include
Medicare Part D notices in open enrollment
packets they send out prior to Oct. 15.
Creditable Coverage
A group health plan’s prescription drug
coverage is considered creditable if its
actuarial value equals or exceeds the
actuarial value of standard Medicare Part D
prescription drug coverage. In general, this
actuarial determination measures whether
the expected amount of paid claims under
the group health plan’s prescription drug
coverage is at least as much as the
expected amount of paid claims under the
Medicare Part D prescription drug benefit.
NEW GUIDANCE ON HEALTH CARE TRANSPARENCY
On Aug. 19, 2022, federal agencies released
a final rule and FAQs regarding the ban on
surprise medical billing and other health
care transparency requirements.
Final Rule on Surprise Medical Billing
The final rule implements certain disclosure
requirements related to information that
health plans and issuers must share about
the qualifying payment amount. It also
finalizes specific changes related to the
payment dispute resolution process in light
of ongoing litigation.
Updated Model Notice
Beginning in 2022, health plans and issuers
must disclose certain balance billing
protections to participants. An appendix to
the FAQs includes an updated version of
the model notice for this disclosure
requirement. Plans that use the model
notice must use the updated version for
plan years beginning on or after Jan. 1,
2023.
Posting of MRFs on a Public Website
Health plans and issuers must disclose, on a
public website, detailed pricing information
in three separate machine-readable files
(MRFs), beginning as early as July 1, 2022.
According to the FAQs, health plans are not
required to create their own public
websites for posting MRFs. Rather, a health
plan can satisfy the MRF disclosure
requirement by entering into a written
agreement under which a service provider
(such as a TPA) posts the MRFs on its public
website on behalf of the plan. Employers
who take this approach should monitor
their service providers to ensure they
comply with this requirement.
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