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