Departments Issue ACA Implementation FAQ Part 56 on Prescription Drug and Health Care Spending
Published December 27, 2022
The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) released Affordable Care Act (ACA) Frequently Asked Question (FAQ) Part 56 as guidance to remind group health plans and health insurance issuers of reporting requirements for certain information related to prescription drug and other health care expenditures.
The FAQ addresses whether the Departments will take enforcement action against any plan or issuer that makes a good faith effort to comply with the prescription drug and health care spending reporting requirements for 2020 and 2021 data.
The FAQ includes clarifications and flexibilities with respect to reporting requirements:
- Multiple submissions by the same reporting entity allowed
- Submissions by multiple reporting entities allowed
- Aggregation restriction suspended
- Submission of premium and life-years data by email available for certain group health plans
- Reporting on vaccines optional
- Reporting amounts not applied to the deductible or out-of-pocket maximum optional.
The Departments expect that plans and issuers will continue to work in good faith toward full compliance with these requirements, and they will continue to monitor stakeholder efforts to comply to determine whether additional guidance is needed in advance of future reporting deadlines.