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Consolidated Appropriations Act and Transparency in Coverage
January 5, 2022

This article is for all providers caring for our members

As you know, many provisions of the Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule began impacting our members starting Jan. 1, 2022. As providers caring for our members, some of these provisions may impact you as well.

Here are highlights of these federal requirements. We’ll continue to publish more information as it becomes available. We advise you to consult with your own legal advisors for information on the obligations that may apply to your practice.

Provider directory (plan years beginning on or after Jan. 1, 2022)

CAA requires provider directory information to be verified every 90 days. Providers and health insurers have roles in fulfilling this requirement to maintain an accurate directory for members.  Read more on the new requirements. 

Machine-readable files

Health insurers are required to publicly display certain health care price information via machine-readable files on their websites beginning July 1, 2022. These machine-readable files will include negotiated rates with in-network providers, allowed amounts for out-of-network providers and may include prescription-drug pricing. 

Member ID cards (plan years beginning on or after Jan. 1, 2022)

The CAA requires that member ID cards include deductible information and out-of-pocket maximums. Starting in the 2nd quarter of 2022, we will begin re-issuing cards in the new format. Members’ current cards remain valid for all services. and member ID numbers will not change. Members who have questions about their new ID card can contact the Member Services 1-800 on the back of their card.

Continuity of Care (plan years beginning on or after Jan. 1, 2022)

Most of our group and fully insured plans include a period of continuity of care at in-network reimbursement rates when a provider leaves our networks. Continuity of care applies to members who are undergoing active treatment for a serious or complex condition, pregnant, or a terminal illness. The CAA requires up to 90 days of continued, in-network care for affected members when:

  • A provider’s network status changes (note that this does not include for-cause terminations)
  • A group health plan changes health insurance issuer, resulting in the member no longer having access to a participating provider in our network. 

For members who qualify for continuity of care, you will need to accept payment at the in-network rate.

No Surprises Act (beginning on Jan. 1, 2022)

Under the No Surprises Act, most out-of-network providers will no longer be allowed to balance bill patients for the difference between the provider's charge and the allowed amount for:

Learn more.

Gag Clauses (effective Dec. 27, 2020)

CAA prohibits health insurers and group health plans from entering into provider agreements that include gag clauses related to provider cost and quality information. If any of our provider contracts include language that contradicts the CAA gag clause requirement, the contract language will be remediated, and in the interim, the language will be considered unenforceable as a matter of law.