In December 2020, the U.S. Congress passed the Consolidated Appropriations Act (CAA) which builds on prior hospital and health plan transparency legislation and regulation by adding requirements that improve purchaser decision-making, network design, and anti-competitive contracting. 

Self-funded employer sponsored health plans are subject to the provisions of the CAA which include such items including member decision making, such as price comparison tools, advanced EOBs, accurate provider directories, and new plan ID cards. The provisions also include new purchaser decision making support, such as eliminating gag clauses; health plan price transparency; prescription drug transparency; broker/consultant financial disclosures. In addition, the CAA advances the mental health and substance abuse parity requirements.

Here are some resources you can use to better understand your fiduciary responsibilities under the CAA, as well as understand the compliance process and early results from employers that have already been audited. Please note that mental health parity has been the law since 2008 and federal regulators believe that employers should be much further along in compliance with these requirements than newer provisions.

Note: these resources were current as of the date they were posted and more current information may now be avaialble, so please use this information as background and see current information for any final decisions.

National Academy for State Health Policy: Transparency Regulations and the CAA: A Checklist for SEHPs. Although specifically addressing state employee health plans, this website provides a good overview of the requirement and steps employers can take. Note that all of the cited provisions apply to non-state employee health plans as well.

DOL, HHS, and Treasury: Report to Congress "Realizing Parity, Reducing Stigma, and Raising Awareness: Increasing Access to Mental Health and Substance Use Disorder Coverage" This report highlights the increased emphasis on enforcement and provides results of the early comparative analysis submitted by employers re: mental health parity.

Employee Benefits Security Administration: Compliance Assistance Guide: Appendix A-Self-Compliance Tools (mental health parity) Please note the disclaimer on this site:  "the 2020 MHPAEA Self-Compliance Tool was last updated before the enactment of the Consolidated Appropriations Act, 2021 (CAA), and while it suggests using the tool as a best practice, it does not reflect that plans and issuers subject to MHPAEA are now required to perform and document their NQTL comparative analyses under the CAA. Plans and issuers that have carefully applied the guidance in the Self-Compliance Tool should be in a strong position to comply with the CAA’s requirement to perform and document a comparative analysis with respect to the design and application of NQTLs.

The Leapfrog Group, National Alliance, ERIC, and Health Transformation Alliance: CAA Compliance Center Resources, upcoming webinars, and recordings of previous webinars on CAA compliance.

MBGH members are invited to participate in HealthCare 21 Business Coalition's upcoming webinars in March and April on CAA fiduciary requirements. Check out the MBGH Calendar for these and other CAA webinars.