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HHS Releases Instructions for Prescription Drug and Health Care Spending Reports



Prescription Drug and Health Care Spending: Supporting Documents; Prescription Drug Data Collection (RxDC) Reporting Instructions

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HHS has released instructions for reporting data under a transparency provision included in the Consolidated Appropriations Act, 2021 (CAA), which requires group health plans and insurers to annually report prescription drug and health care spending, premiums, and enrollment information to the government (see our Checkpoint article). In November 2021, the DOL, HHS, and IRS issued interim final regulations describing the content and timing requirements for the reports (see our Checkpoint article). Among other things, the regulations provide that plans and insurers must submit information based on the “reference year,” which is defined as the calendar year immediately preceding the calendar year in which the data submission is due. According to the CAA, calendar year 2020 information is required to be submitted by December 27, 2021; calendar year 2021 information by June 1, 2022; calendar year 2022 information by June 1, 2023; and so on. However, the agencies advised that they will not initiate enforcement actions against plans or insurers that submit the required data for the 2020 and 2021 reference years by December 27, 2022.

HHS has now released supporting documents for the regulations, including data submission instructions for plans and insurers for the 2020 reference year. In addition to reviewing who must report and when, the instructions explain how the data is to be submitted through the RxDC module in the Health Insurance Oversight System (HIOS). There are also detailed explanations of, for instance, spending categories, data aggregation rules by state and market segment, and rebate and fee allocation methods, including a number of detailed examples.

EBIA Comment: Insurers and TPAs will want to familiarize themselves with these instructions since they are likely to be submitting these reports. Notably, CMS encourages reporting by TPAs on behalf of self-insured health plans. CMS indicates that TPAs should combine, within each state and market segment, the data for all the self-insured plans for which it is reporting to reduce the number of submissions and the total amount of data uploaded into HIOS. The agencies have urged plans and insurers to start working to ensure that they are be able to report by December 27, 2022. They have also encouraged plans and insurers to submit by either the December 27, 2021 or June 1, 2022 deadlines if they are able. For more information, see EBIA’s Health Care Reform manual at Section XXXVI.L (“Prescription Drug and Health Care Spending Reporting”). See also EBIA’s Self-Insured Health Plans manual at Section XXIX.D.4 (“Prescription Drug and Health Care Spending”) and EBIA’s ERISA Compliance manual at Section XXI.C (“Caution Regarding Additional Obligations”).

Contributing Editors: EBIA Staff.

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