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Course Details

Course Information
  • smart_display Format

    On-Demand

  • signal_cellular_alt Difficulty Level

  • work Practice Area

    ERISA

Date & Time
  • event Date

    Wednesday, May 4, 2022

  • schedule Time

    1:00 p.m. ET./10:00 a.m. PT

  • timer Program Length

    90 minutes

Credit Information

  • This 90-minute webinar is eligible in most states for 1.5 CLE credits.

$347.00
CLE
ALL

This CLE course will guide employee benefits attorneys, plan sponsors, and plan administrators and service providers through new price transparency rules for health plans. The panel will discuss key provisions of the final rule; the rule's impact on plan sponsors, insurers, and service providers; requirements and new mandates; administrative and operational challenges; and best practices to promote compliance.

Faculty

Margaux J. Hall
Partner
Ropes & Gray

Ms. Hall is a leading lawyer in drug pricing, managed care and value-based payment arrangements. She brings to clients an understanding of the transformative legal and policy issues affecting pharmaceutical manufacturers, and the life sciences and health care sectors more broadly.

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William O. Williams
Insurance Regulation Practice Group Leader
Frost Brown Todd

Mr. Williams practices administrative and regulatory law in the areas of insurance and health care, representing health insurance and health care companies. With more than 22 years of in-house experience at one of America’s largest health care companies, he has advised licensed and risk-bearing entities in administrative, regulatory, and enforcement matters before state and federal agencies. Mr. Williams managed major in-house law department functions supporting commercial health insurance, Medicare, and Medicaid products and operations, and has extensive knowledge and experience resolving complex legal, regulatory and operational problems for his clients. He works closely to understand their business, providing legal advice that helps them achieve their goals and objectives in an ever-changing legal and regulatory environment. Mr. Williams leads Frost Brown Todd’s Insurance Regulation Practice Group and is a member of the firm’s Insurance Industry Team and Health Care Innovation Team. He is AV rated by Martindale-Hubbell, and a member of the Federation of Regulatory Counsel (FORC) and of the American Health Law Association (AHLA).

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Description

In 2020, the Departments of Health and Human Services, Treasury, and Labor jointly issued a "Transparency in Coverage" final rule. The rule imposes significant transparency requirements and mandates on group health plans and insurers in the individual and small group markets.

Under the final rule, affected plans and insurers must disclose cost-sharing estimates, negotiated rates for in-network providers, out-of-network allowed amounts and charges. The rules are subject to enforcement under the ACA, requiring strict operational procedures to promote compliance and help avoid state and DOL enforcement actions.

The final rule does not change existing privacy and security requirements under HIPAA or other applicable state and federal laws. Employee benefits attorneys, plan sponsors, and insurers must implement procedures aligned with the mandates under the final rule while maintaining compliance with other applicable state and federal laws.

Listen as our panel discusses key provisions of the final transparency in coverage rule, requirements and mandates, administrative and operational challenges, and best practices and next steps for plan sponsors, insurers, and service providers.

Outline

  1. Key provisions of the price transparency rules
  2. Application of disclosure requirements to health plans
  3. Disclosure of cost-sharing information
  4. Disclosure of negotiated in-network and out-of-network rates
  5. Shared savings in the medical loss ratio
  6. Best practices and next steps for plan sponsors, insurers, and service providers

Benefits

The panel will review these and other key issues:

  • What are the key provisions of the price transparency rules?
  • How do the rules impact health plan sponsors, insurers, and service providers?
  • What are the disclosure requirements for cost-sharing, in-network rates, out-of-network amounts, and shared savings?
  • What potential shared savings are available under the revised MLR regulations?
  • What are the next steps and best practices to maintain compliance with the new rules?