The Consolidated Appropriations Act 101 - Comply or Die?
The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care.
The price transparency component is where the opportunity lies for employee benefits brokers and their employers to uncover the source of their high cost claims, and then take appropriate fiduciary responsibility in order to pay more appropriate unit costs for healthcare. While there is a cost associated with ensuring you are compliant, the opportunity to retain and win new business for consultants is massive.
Right now, opaque network contracts make it difficult for healthcare consumers to know the cost of care prior to receiving it, and it is nearly impossible to make an informed decision as a patient. The CAA will have a dramatic impact on Americans' ability to price shop on where to go for care, as well as their ability to plan for their out of pocket expense(s).
Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day. The goal for employers immediately is not to be perfect by 12/27/22, but to at least show that they made a good faith effort to be compliant.
The goal of the CAA is simple: People should be able to know the price ahead of time, shop using that price as well as quality of care metrics, and then they shouldn't be slapped with a giant, surprise balance bill afterward. At the end of the day, the goal is to allow people to have the tools to shop for healthcare the way that they do so for any other product or service.
The CAA has 4 Pillars:
1. Gag clauses in admin agreements that prevent employers from getting their own data
2. Broker Compensation Disclosure
3. More Info about Prescription Drugs
4. Mental Health Parity
Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant. Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention!
https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs
Chapters:
:30 Intro to Podcast
1:10 Intro to Drew Kalestad
1:47 Intro to Tony Sorrentino
4:15 Defining the Problem
7:45 Agility Partners Origin
12:45 What is the CAA?
18:45 Compliance with Tony
24:22 The 4 Pillars of the CAA
27:30 The Opportunity of the CAA
31:41 What is HP Fid?
36:45 How to be Compliant TODAY
40:29 Closing Thoughts
