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Added by section 10101 of the Manager’s Amendment. Requires plans not offered through an Exchange to submit information required under section 1311(e)(3) – such as claims payment policies and practices and enrollment/disenrollment data – to HHS and the State insurance commissioner as well as make it available to the public.
2012
The Exchange establishment final rule (March 27, 2012) finalizes several details regarding transparency in coverage – from section 1311(e)(3) – although no separate rulemaking has occurred on PHSA section 2715A and the application of transparency requirements outside of Exchanges.
2013
On April 29, 2013, DOL, Treasury and HHS issued FAQs clarifying that waivers from the annual limit requirements will expire on the approved expiration date, notwithstanding any modifications that plans may make to their plan or policy years. The FAQs also clarify that the ACA’s provider non-discrimination and clinical trial coverage provisions are self-implementing and that no regulations are expected “in the near future.” The Departments note that the Qualified Health Plan transparency reporting requirements under section 1311(e)(3) will take effect “only after QHPs have been certified as QHPs for one benefit year,” adding that outside-the-Exchange reporting requirements under PHSA 2715A will not take effect sooner than this.
‘‘SEC. 2715A [42 U.S.C. 300gg–15a]. PROVISION OF ADDITIONAL INFORMATION. ‘‘[As added by section 10101(c)] A group health plan and a health insurance issuer offering group or individual health insurance coverage shall comply with the provisions of section 1311(e)(3) of the Patient Protection and Affordable Care Act, except that a plan or coverage that is not offered through an Exchange shall only be required to submit the information required to the Secretary and the State insurance commissioner, and make such information available to the public.
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