Think of reporting your organization’s prescription drug spending as cooking a complex and elaborate dish. If you don’t follow the recipe — if you skip steps or leave out ingredients or don’t conform to the prescribed timing — the finished product won’t be served as intended.
For HR professionals responsible for compliance with Section 204 of the Consolidated Appropriations Act (CAA), the Centers for Medicare & Medicaid Services (CMS) has your recipe. Actually, at 59 pages, it’s more of a cookbook. It’s called “Prescription Drug Data Collection (RxDC) Reporting Instructions,” and it contains all the information you’ll need to complete and submit the Rx data the federal government requires.
As the document explains, “Section 204 requires group health plans (plans) and health insurance issuers (issuers) offering group or individual health insurance coverage to submit information about prescription drugs and health care spending to the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (the Departments). In addition, the Director of the Office of Personnel Management (OPM) requires Federal Employees Health Benefits carriers (carriers) to submit Section 204 data to HHS. The Centers for Medicare & Medicaid Services (CMS) is collecting Section 204 data submissions on behalf of the Departments and OPM.”
The deadline for submitting all this information to CMS is December 27.
Even with your recipe/cookbook in hand, you still may have questions regarding Section 204 and other compliance issues. Alera Group is here to help.
RxDC reporting is one of the timely topics you can learn more about by attending our November 17 webinar, Q4: What’s Trending in Compliance, the next event in our Alera Engage series. During the one-hour session, our compliance experts will also discuss:
- Cafeteria Plan documents most businesses should be planning to update in December;
- General compliance issues regarding group health plans;
- Important considerations regarding the Supreme Court’s Dobbs decision on abortion, most of which will hinge on the outcome of this fall’s elections for state and national offices.
The COVID-19 pandemic, a change in presidential administrations and a raft of new legislation have made the past few years like a maelstrom within a tsunami for human resource professionals. Alera Engage webinars are designed to help you calm the waters and get back on solid footing with your benefits and compliance challenges. Our November 17 event will leave you better prepared for what’s ahead in Quarter 4 and beyond.
Allow Time to Prepare
In the meantime, it’s not too early to begin the reporting process.
Open Enrollment season is already underway, and that can become all-consuming for human-resource professionals. Don’t let it. The December 27 deadline for RxDC reporting will be here before you know it, and the reporting process is — returning to our recipe analogy — the HR equivalent of making timpano, so you’ll need time. As the Society for Human Resource Management (SHRM) notes:
“Although plans can contract with their third-party administrators, pharmacy benefit managers or other plan providers to meet these requirements, not all providers are willing to report all of the data elements. This means that employers may need to register for a Health Insurance Oversight System (HIOS) account to submit some of the required information.
“With the first RxDC reporting deadline of Dec. 27, 2022, fast approaching, plan administrators should discuss RxDC reporting with their providers now to develop a compliance plan. As the CMS warns, HIOS accounts can take up to two weeks to create. So, waiting until December to start working on this is not recommended.”
If you haven’t started the reporting process already, do so soon. We’ll do our best to address likely questions during the webinar. To register, click on the link below.
About the Author
Vice President of Compliance, Employee Benefits
Danielle Capilla is focused on enhancing Alera Group’s existing compliance capabilities and building new, world-class compliance solutions for our employee benefits clients. Her areas of expertise include healthcare and employee benefit compliance, with an emphasis on the Patient Protection and Affordable Care Act. Additionally, she regularly works with issues regarding Section 125 plans, COBRA, ERISA, Medicare, HIPAA and consumer-driven healthcare plans. Danielle earned her JD in Health Law from DePaul University College of Law. Her background in law enables her to simplify complex topics, helping Alera Group clients navigate the intertwined landscape of healthcare regulation and their benefit plans.