Brown & Brown, Inc. · NYSE:BRO
Brown & Brown — Conference Presentation (April 2023)
33 slides from Brown & Brown's conference presentation, Apr 20, 2023
Slide 1: This Webinar Will Start Momentarily
This Webinar Will Start Momentarily. Thank you for joining us!
Slide 2: Transparency Update
Transparency Update April 20, 2023 Presented By: Presented by the Regulatory and Scott Wold and Amanda Olimb Legislative Strategy Group
Slide 3: Disclaimer
DISCLAIMER Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview o
Slide 4: Agenda
Agenda 1 Price Comparison Tool 2 Prescription Drug Reporting 3 Gag Clause Attestations BROWN & BROWN | 4
Slide 5: Price Comparison Tool
Price Comparison Tool
Slide 6: Price Comparison Tool
Price Comparison Tool • Allows participants to compare the amount of cost-sharing that the individual would be responsible for paying under the plan with respect to the receipt of a specific item or service by a particular provider • Self-service tool available on Internet website (and by telephone
Slide 7: Price Comparison Tool
Price Comparison Tool • Starting with the first plan year beginning on or after January 1, 2023 » Must disclose cost-sharing and pricing for 500 specific items and services » List available at http://www.cms.gov/healthplan-price-transparency/resources/500-items-services » Updated quarterly • Startin
Slide 8: Price Comparison Tool
Price Comparison Tool Tool Must Provide the Following Information: 1. Estimated cost-sharing liability ($) for a covered item 5. If the item or service is part of a bundled payment or service, including all items and services for which arrangement, a list of the items or services included in benefit
Slide 9: Price Comparison Tool
Price Comparison Tool • More to come? • Both final TiC regulations under the ACA and the CAA include this requirement • Agencies addressed interaction between the two in FAQs About ACA and CAA Part 49 » Intend to propose rules regarding whether compliance with final TiC regulations satisfies the CAA
Slide 10: RxDC Reporting
RxDC Reporting
Slide 11: General Overview of Requirements
General Overview of Requirements • Added to ERISA, Internal Revenue Code and PHSA by CAA of 2021 • Generally due by June 1st of the year following the applicable reporting year (i.e., immediately preceding calendar year) • Applies to fully insured and self-insured group health plans, but: » Does not
Slide 12: General Overview of Requirements: Penalties
General Overview of Requirements Penalties • Regulatory agencies have provided no guidance regarding enforcement or potential penalties • RxDC reporting requirement added as Section 9825 of the Internal Revenue Code » Section 9825 is part of Chapter 100 » Section 4980D imposes an excise tax on any f
Slide 13: General Overview of Requirements: Guidance Issued to Date
General Overview of Requirements Guidance Issued to Date • Interim Final Regulations issued 11/23/21 » https://www.govinfo.gov/content/pkg/FR-2021-11-23/pdf/2021-25183.pdf • CMS published filing instructions; most recently updated in March 2023 » https://regtap.cms.gov/reg_librarye.php?i=3860 • Agen
Slide 14: What Information Must Be Reported
What Five General Categories of Information Information 1 Group Health Plan List – File P2 Must Be Premiums and Life Years (Covered Lives) – File D1 Reported 2 3 Medical Spending by Category – File D2 4 Rx Cost Information – Files D3-D8 5 Narratives Carriers, TPAs and PBMs that file on behalf of gro
Slide 15: Plan List
Plan List • P2 applies to group health plans • Must be submitted by any reporting entity that submits a file on behalf of a group health plan • Includes various pieces of plan identifying information (e.g., plan name, plan number, plan year, plan sponsor name, etc.) and information about issuer, TPA
Slide 16: D1: Life Years and Premiums
D1: Life Years and Premiums Six Data Elements 1. Life Years = Average number of members 3. Admin fees paid (aggregate for plan) (employees and dependents) throughout the year 4. Stop loss premium paid (aggregate for plan) • First, calculate total member months 5. Average monthly premium paid by memb
Slide 17: Data Files (D2 – D8)
Data Files (D2 – D8) D2 • Medical spending by category (hospital, primary care, specialty care, other medical costs and services, and medical benefit drugs (known amounts and estimated amounts) D3 through D8 • Top 50 Brand Drugs, Top 50 Most Costly Drugs, Top 50 Drugs by Spending Increase, Rx Totals
Slide 18: Filing Procedure
Filing Procedure Submit Data Through the RxDC Module in the Health Insurance Oversight System (HIOS) • Instructions for using the RxDC module are in the User Manual • Exception: FAQ 56 indicates that, for applicable calendar year 2020 and 2021 filing, premium and life years data (i.e., D1 data) coul
Slide 19: Who Files?
Who Files? • Using a third party (e.g., insurance carrier, TPA, • Carrier/TPA/PBM will not have all this information PBM, etc.) (especially premium information) » Regulations allow fully insured group health » For initial filing, carriers/TPAs/PBMs could omit plans to shift all responsibility to car
Slide 20: Who Files?
Who Files? Rules regarding multiple files • Original instructions indicate that multiple reporting entities can submit reports on behalf of a group health plan, but multiple reporting entities should not submit the same data file for a plan » Example: PBM could submit data files with Rx drug informa
Slide 21: Updates for 2023
Updates for 2023 • Updated instructions issued in March • Revision to P2 File – HIOS Plan ID column replaced • Key changes/clarifications include: to collect information about carve-out benefits » Multiple data files of same type – “if entities are • Data files revised to replace Issuer or TPA Name
Slide 22: Gag Clause Attestations
Gag Clause Attestations
Slide 23: General Overview of Requirements
General Overview of Requirements • Prohibition on gag clauses was effective December 27, 2020 • Applies to fully insured and self-insured group health plans, including plans subject to ERISA, non-Federal governmental plans and church plans » Does not apply to plans providing excepted benefits and ac
Slide 24: Recent Regulatory Guidance
Recent Regulatory Guidance FAQ About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 57 • Issued February 23, 2023 • Provides examples of prohibited gag clauses » A provision in a contract between a TPA and group health plan indicating that the plan may not share in
Slide 25: Attestations
Attestations • A group health plan must annually submit to the DOL • Departments have issued instructions, a system user an attestation that it is complying with these manual and a Reporting Entity Excel Template requirements » Available at: https://www.cms.gov/cciio/programs- • FAQ 57 indicates fir
Slide 26: Surprise Billing
Surprise Billing
Slide 27: Ongoing Developments For IDR Process
Ongoing Developments For IDR Process Background New Regulatory Guidance • Payment from plan to provide for claims coverage • Generally, applies to determinations made on or by surprise billing rules determined by negotiation after February 6, 2023, for items/services furnished or IDR process on or a
Slide 28: COVID Related Rules
COVID Related Rules
Slide 29: Generally: FFCRA and CARES Act
Generally: FFCRA and CARES Act B E N E F I T P L A N M A N D AT E S F O R C O V I D - R E L AT E D C A R E A N D P O S T- P H E Current Rules until the end of the Public Health End of Public Health Emergency: 5/11/23 Emergency (PHE) (different than NE/OP): • Cost-sharing for diagnostic/testing items
Slide 30: Notice 2020-15 and HDHPs
Notice 2020-15 and HDHPs HDHP COVERAGE AND COVID CARE Current Rules until the end of the Public Health » FFCRA FAQs 58 - An individual covered by an Emergency (different than NE/OP): HDHP that provides medical care services and items purchased related to testing for and • HDHPs may provide first dol
Slide 31: FFCRA and CARES Act
FFCRA and CARES Act B E N E F I T P L A N M A N D AT E S F O R C O V I D - R E L AT E D C A R E Carriers/TPAs and Plan Amendments Carriers and TPAs Plan Amendments • Some carriers and TPAs will provide options for • Employers/Plan sponsors should review plan employers to either continue with PHE lev
Slide 32: HRCI and SHRM Credits
HRCI and SHRM Credits This Program, ID No. 622832,has been approved for 1.00 HR (General) recertification credit hours toward aPHR™, aPHRi™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Brown & Brown is recognized by SHRM to offer Professi
Slide 33: Find your solution at BBrown.com
Find your solution at BBrown.com DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intend