On October 29, 2020, the Centers for Medicare and Medicaid Services (CMS) released a new rule aimed at improving transparency in health plans. Among other things, it requires individual and group health plans to release a statement to consumers disclosing their cost-sharing requirements with respect to a certain treatment or service. The same statement must also include information about whether the plan has adopted a copay accumulator program (i.e., whether the plan will exclude copay assistance or other third-party payments from the calculation of the patient’s deductible or out-of-pocket maximum). The health plan must make this information available through an internet-based self-service tool, and the information provided in that tool must be in plain language, without a subscription or other fee, and offered in real-time. This information must also be available in plain language in paper format and without a fee upon request of the patient. This change will go into effect for plans beginning on or after January 1, 2023 with respect to a list of 500 items and services, which will be posted on a publicly available website and on or after January 1, 2024 for the remainder of covered items and services. Read the full rule here.
Last Updated on October 29, 2020 by Aimed Alliance
