Compliance Corner

January 18, 2023

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Podcast Episode 131: Healthcare Policy and Compliance Issues for Employers to Consider in 2023

In this episode, Suzanne Spradley and Chase Cannon highlight several areas of healthcare policy and compliance that will be on center stage in 2023. Suzanne starts with a discussion of transparency in healthcare and prescription drug costs, including several compliance requirements that will take effect in 2023. Suzanne and Chase discuss state compliance challenges, including abortion travel coverage, paid family and medical leave, and new legislation aimed at providers (but could indirectly impact employers). Suzanne closes by addressing the extension of telehealth relief with respect to HSA eligibility and what to look for in 2023 on the mental health parity analysis requirement.

Periodically, NFP's legal experts make the subject of compliance personal for a wide audience. By breaking down the daunting details of emerging policies and bridging the gap between legislation and what it means for the listener, Chase Cannon and Suzanne Spradley make compliance issues relatable and relevant. Visit our Soundcloud page for the most up-to-date episode.

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February Get Wise Wednesdays – Register Now

Topic: Spread the Love: State Compliance Considerations

Description: As companies continue to expand geographically and hire more remote employees, it is important to remember some states have additional benefits obligations for some employers. Join us as we discuss state-specific compliance considerations such as annual filings, mini-COBRA laws, paid leave and more.

Date/Time: February 15, 2023
2:00 to 3:00 p.m. CT (3:00 to 4:00 p.m. ET)

Register Now

This program is pending approval for 1.0 (general) recertification credit hours toward PHR, SPHR and GPHR recertification through the HR Certification Institute. For more information about certification or recertification, visit the HR Certification Institute website at hrci.org.

Reminder: CAA Pharmacy Benefit and Healthcare Spending Reporting Deadline Approaching

Under the CAA, Section 204, insured and self-insured group health plans are required to report significant information regarding prescription drug and healthcare spending to the government. The 2020 and 2021 calendar year data submissions are due by December 27, 2022. However, under recently announced relief, a submission grace period is available to employers who make a good faith submission of the 2020 and 2021 data on or before January 31, 2023.

The data must be submitted to the Health Insurance Oversight System (HIOS) in files and formats specified by CMS. As applicable, employers should work closely with their carriers, third-party administrators, pharmacy benefit managers and other vendors to ensure the required information is timely and accurately provided. In some cases, employers that sponsor self-insured plans may need to submit data directly to HIOS.

Detailed information regarding the reporting requirements, including instructions, FAQs and a HIOS portal user guide, is available on the CMS website.

Reminder: Price Comparison Tool Requirements Begin to Take Effect

Effective for plan years beginning on or after January 1, 2023, the Transparency in Coverage Final Rule (TiC) requires most group health plans and carriers to make personalized out-of-pocket cost information available to participants through an internet-based self-service tool or in paper format (upon request). The self-service tool is designed to provide participants with real-time, accurate estimates of their cost-sharing liability for healthcare items and services from different providers prior to receiving care.

The TiC provided phased-in effective dates for the internet self-service tool requirement. An initial list of 500 “shoppable” items and services must be made available through the tool for plan years beginning on or after January 1, 2023. For plan years beginning on or after January 1, 2024, all items and services, including prescription drug and durable medical equipment, must be made available.

Employers should consult with their carriers or third-party administrators (TPAs) to ensure timely implementation of the self-service tool. Fully insured plans can contract with their carrier to assume liability for the requirement. Self-insured plans can contract with TPAs or other vendors but remain responsible for satisfying the requirements.

For further information regarding the TiC and self-service tool requirements, please see our December 20, 2022 FAQ and the Transparency in Coverage Final Rule and Transparency in Coverage Final Rule Fact Sheet and our November 10, 2020 article.

Reminder: Form W-2 Cost of Coverage Reporting

Annually, large employers must report the aggregate cost of group health coverage provided to employees on Form W-2. The coverage must be reported on a calendar-year basis, regardless of the ERISA plan year or policy year. The reporting is intended for informational purposes for employees.

This ACA requirement applies to employers that filed 250 or more Form W-2s in the prior calendar year. Employer aggregation rules do not apply for this purpose. In other words, the number of Form W-2s is calculated separately without consideration of controlled groups. Self-insured plans that are not subject to COBRA (including church plans), multiemployer plans and Indian tribal governments are currently exempt from the Form W-2 reporting requirement.

For further information, please request a copy of our ACA: Form W-2 Reporting Requirement publication.

Reminder: Upcoming ACA Reporting Deadlines for Forms 1094/1095

Annual ACA reporting deadlines for employers that sponsored group health plans in 2022 are approaching.

Applicable large employers (ALEs) with 50 or more full-time employees (FTEs), including full-time equivalent employees, in the prior year who sponsored group health plans (whether insured or self-insured) must comply with IRC Section 6056 reporting in early 2023. Specifically, ALEs must complete and distribute Form 1095-C to full-time employees by March 2, 2023. The form should detail whether the employee was offered minimum value, affordable coverage during 2022. The forms may be mailed, electronically delivered or delivered by hand (although proof of delivery in some manner is recommended).

Employers who sponsored a self-insured plan during 2022 must comply with Section 6055 reporting in 2023. Self-insured employers with 50 or more FTEs must complete Section III of Form 1095-C detailing which months the employee (and any applicable spouse and dependents) had coverage under the employer’s plan. If the self-insured employer has fewer than 50 FTEs, it must complete and distribute a Form 1095-B with such information. Again, the forms must be delivered to employees by March 2, 2023.

If the self-insured employer has fewer than 50 FTEs, an alternative is available to distributing Form 1095-B to individuals. Such a small employer is permitted to post a clear and conspicuous notice on their website of the availability of the document and the necessary contact information to request it. Any such request must be fulfilled within 30 days. No such alternative is available for Form 1095-C.

Employers must also file the forms with the IRS by February 28, 2023, if filing by paper, and March 31, 2023, if filing electronically. The filing must include the transmittal Form 1094-C (if filing Forms 1095-C) or Form 1094-B (if filing Forms 1095-B).

2022 Instructions for Forms 1094/1095-B »
2022 Instructions for Forms 1094/1095-C »
2022 Form 1094-B »
2022 Form 1095-B »
2022 Form 1094-C »
2022 Form 1095-C »