With July 1 fast approaching it is still not entirely clear how, or even if, employers should link to their health plan cost data machine readable files created by their vendors. However, CMS recently gave us the best indication yet that employers might not be required to post this data, or even a link to it, as long as their TPA or vendor publicly posts it on their behalf.
The following Q&A was posted on the CMS health plan price transparency technical clarification site on Friday, June 17 (the emphasis is mine):
Question: May a group health plan that does not have its own website satisfy the requirements of the TiC Final Rules with respect to posting the Allowed Amount file and the In-network Rate file on a public website of the plan, if the plan’s service provider posts the Allowed Amount file and the In-network rate file on its public website on behalf of the group health plan? (New 6/17/22)
If a group health plan does not have a public website, the plan may satisfy the requirements for posting the Allowed Amount file and the In-Network file by entering into a written agreement under which a service provider (such as a TPA) posts the Allowed Amount file and the In-network Rate file on its public website on behalf of the plan. However, if a plan enters into an agreement under which a service provider agrees to post the Allowed Amount file and the In-network Rate file on its public website on behalf of the plan, and the service provider fails to do so, the plan violates these disclosure requirements. The Departments intend to follow up with the issuance of formal guidance soon.
The guidance states that if the plan does not maintain a public website it can rely on the vendor to make the data publicly available. Importantly, it does not say anything about the employer’s public website. Very few employers maintain a public website specifically for their employer sponsored health plan. While we wish CMS had been a little clearer, we believe that the promised guidance will confirm that the employer is not required to post the data, or a link to the data, on its regular company website as long as its vendor is doing it on behalf of its plan.
Unfortunately, we can’t promise that that guidance will be released before July 1. In the meantime, employers who want to be conservative should be preparing to post a link to the appropriate data files provided by their TPA or administrator. We expect that many other employers will adopt a wait-and-see approach, hoping that the issue will be clarified by CMS soon.
You can find the recently released guidance at https://www.cms.gov/healthplan-price-transparency/resources/technical-clarification