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On August 20, 2021, the Departments of Labor, Health and Human Services, and the Treasury (collectively, “the Departments”) issued a series of FAQs on certain surprise billing and transparency provisions of the Consolidated Appropriations Act, 2021 (“CAA”) and the 2020 Transparency in Coverage regulations (“TiC”). Pursuant to the FAQs, enforcement of the following TiC and CAA deadlines is deferred or on hold for group health plans:

Posting of three machine-readable data files (TiC)

Original deadline: For all three files, first day of the plan year beginning on or after 1/1/22.


  • For the in-network provider rate files and out-of-network allowed amounts and billed charges files, enforcement is deferred until 7/1/22 for plan years beginning on or after 1/1/22. However, 2022 plans years beginning on or after July 1, 2022, should post the files in the month in which the plan year begins, consistent with the original deadline above.
  • For the prescription drug file, enforcement is on hold while the Departments consider whether to eliminate the TiC requirement due to the CAA’s drug reporting requirements.

Web and phone-based participating providers price comparison tool (CAA)

Original deadline: Plan years beginning on or after 1/1/22.

Now: Plan years beginning on or after 1/1/23. The Departments will seek public comments on whether compliance with the TiC’s comparison tool requirements, modified to include a phone support, would satisfy the CAA’s requirements.

Good faith estimates and advance explanations of benefits (CAA)

Original deadline: Plan years beginning on or after 1/1/22.

Now: Enforcement deferred pending rulemaking.

No gag clauses on price and quality data (CAA)

Original deadline: December 27, 2020, and annual attestation of compliance is required.

Now: No change, but the Departments will issue guidance on how to submit attestations and expect to begin collecting them in 2022.

Reporting on drug and plan expenditures (CAA)

Original deadline: 12/27/21, then each 6/1 thereafter.

Now: Enforcement of the 12/27/21 and 6/1/22 reporting deadlines is deferred but reporting is anticipated to be required 12/27/22.

The deadlines for implementation of the CAA’s requirements concerning balance billing disclosures, ID cards, provider directories, and continuity of care remain the same (first plan year beginning on or after 1/1/22); however, the FAQs provide guidance on what good faith implementation would look like for several of these requirements.

The FAQs also clarify that grandfathered plans are generally subject to the CAA’s requirements (in contrast, the TiC’s requirements do not apply to grandfathered plans). For more information on the CAA, see our bulletin.

From all of us here at MMPL, your employee benefits law firm.

Not intended as legal advice.