On Monday, October 5^th, the Federal Departments finally released long-awaited final regulations which are intended to improve and strengthen the existing Transparency in Coverage (TiC) regulations.  What many call Transparency 2.0, these final regulations are primarily intended to address the following problems:

• The TiC Machine-Readable Files (the “TiC Files”) are way too large, which has made it extremely difficult for plan sponsors and their service providers to download, analyze, and evaluate the publicly disclosed pricing information.  
• In addition, the pricing data inputted into the TiC Files (known as the “In-Network Rate File” and the “Out-of-Network Allowed Amount File”) are often times incorrect, inaccurate, and duplicative, which has made it almost impossible to develop an accurate picture of the pricing information and provider patterns in a particular geographic region.

SIIA supports the Trump Administration’s ongoing efforts to improve and strengthen the TiC requirements, and we agree with the Federal Departments that the transparency of the negotiated rates and out-of-network payments disclosed through the TiC Files is vital for self-insured plan sponsors and their service providers, researchers, and policymakers to analyze health care spending, benchmark costs, and inform future policy decisions.

In our comment letter to the proposed TiC regulations (which you can find here), SIIA conveyed support for the now finalized changes to:

• The INN Rate File (which are intended to reduce the size and number of INN Rate Files and improve the standardization, accuracy, and accessibility of the pricing information); and
• The OON Allowed Amount File (which are intended to increase the amount of out-of-network payment data that must be publicly disclosed).

We also supported the now finalized “Additional Contextual Files” (through the new Utilization, Taxonomy, and Text Files) so plan sponsors and their service providers can better understand the pricing information.

SIIA’s comment letter also emphasized that an effective way to ensure that the pricing information inputted into the INN Rate and OON Allowed Amount Files is usable and understandable is to:

• Require the CEO or authorized representative of an insurance carrier or independent TPA that produces the TiC Files for a self-insured plan to “attest” to the completeness and accuracy of the plan’s Files that the carrier or TPA produced; and 
• Clarify that the pricing information that must be inputted into the INN Rate and OON Allowed Amount Files are “plan assets” under ERISA.

Although the Departments did not accept SIIA’s comment to clarify that the TiC pricing information is an ERISA plan asset, the Departments did add an attestation requirement, requiring the CEO or senior official of an insurance carrier or self-insured plan to “attest” the completeness and accuracy of the TiC Files. 

For a more detailed analysis of the final regulations – including this new attestation requirement – please click here.

SIIA applauds the Federal Departments' efforts here, but more needs to be done to increase the accuracy and completeness of the pricing information.  We are hopeful that the Trump Administration will undertake a Transparency 3.0 rulemaking exercise and continue to improve and further strengthen these public pricing disclosure rules.  SIIA will certainly be advocating for the development and release of additional regulations and guidance during the remaining two years of this Administration.

If you have any questions about these final TiC regulations, please contact Chris Condeluci at ccondeluci@siia.org or Anthony Murrello at amurrello@siia.org.