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Guidance Delaying Enforcement of Advanced EOB

Aug. 31, 2021 – Consolidated Appropriations Act (CAA) Update

This article provides general information and is not legal advice. If you have specific questions about compliance with the Consolidated Appropriations Act or the Affordable Care Act, please contact your legal counsel.

In June, our Leadership email series introduced a couple provisions of the Consolidated Appropriation Act (CAA), including the advanced explanation of benefits (AEOB).

On Aug. 20, the federal agencies responsible for overseeing implementation of the CAA – the Departments of Labor, Health and Human Services (HHS), and Treasury – issued FAQs addressing several provisions of the law. Specific to AEOB, the Departments said they will not enforce the provision until some future date that will be set by the Departments. In the meantime, HHS is investigating if interim approaches may be feasible for insured members.

The Departments also delayed enforcement for a few other provisions including the CAA’s price comparison tool and pharmacy reporting requirements. While the CAA requirement may be delayed, our price comparison tool, Heath Care Cost Estimator, is available for members when they log into their secure BlueCross member account.

Additionally, the Departments delayed enforcement for a portion of the Transparency in Coverage final rule that implements an Affordable Care Act requirement. The delay applies to publicly posting in-network rates, out-of-network allowed amounts, and pharmacy prescription drug pricing in machine-readable files (MRFs).

We’re working with the state to determine if they will adopt the same approach to enforcement outlined in the Departments’ FAQs. We’ll update you as we learn more.

At a Glance

This chart summarizes the enforcement delays included in the FAQs:

Provision / Requirement Original Applicability Date Enforcement Delay
AEOB Jan. 1, 2022 Not specified
Price Comparison Tool Jan. 1, 2022 Jan. 1, 2023
Pharmacy Reporting Dec. 27, 2021 Dec. 27, 2022
MRF – in-network file Jan. 1, 2022 July 1, 2022
MRF – out-of-network file Jan. 1, 2022 July 1, 2022
MRF – pharmacy file Jan. 1, 2022 Not specified

We’re Here to Help

Please contact your BlueCross Sales or Account Executive with questions.