GOVERNMENT PROVIDES GRACE PERIOD AND OTHER RELIEF FOR SUBMISSION OF PRECRIPTION DRUG AND HEALTH CARE SPENDING DATA

The Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments) have granted health plans and issuers a grace period to file reports on their prescription drug and healthcare spending.  The first reports, covering 2020 and 2021, were due on December 27, 2022.  In an FAQ issued on December 23, 2022, the Departments acknowledged that the reports are novel and complicated and that plans have encountered “significant operational challenges” in meeting the December 27 deadline.  Stakeholders have expressed concern over issues and errors affecting the first round of reports.

In response to those concerns, the Departments have indicated that they will not take enforcement action against any plan or issuer that takes a good faith, reasonable interpretation of the regulations in making their submissions.  They have also granted plans and issuers a grace period through January 31, 2023, to submit their reports.

The FAQ also affords reporting entities some flexibility regarding the contents and organization of their initial reports.  Since most employers will be relying on their TPAs or insurance companies to satisfy their reporting obligations, we will not report on those details here but interested readers can check the FAQ.  However, there is one feature that may be of broader interest.

The FAQ provides that, for purposes of the initial report, “more than one reporting entity may submit the same data file type on behalf of the same plan or issuer, instead of working together to consolidate all of the plan’s or issuer’s data into a single data file for each type of data.”  This may provide some additional breathing room for employers with self-insured plans that use multiple service providers and are who having trouble getting those service providers to coordinate their reporting efforts.

The information and content contained in this blog post are for general informational purposes only, and does not, and is not intended to, constitute legal advice. As always, for specific questions concerning your health and welfare plan, or for help in operating your plan during the current COVID-19 crisis, please consult your own ERISA attorney or professional advisor.