Applies to all carriers and plans subject to transparency in coverage federal rule (45 CFR 147.212) and s. 204 of the Consolidated appropriations act (CAA) (PL 116-260).
Additionally, regulation applies to all carriers subject to the reporting requirements related to prescription drug and health care spending found at 45 CFR 149.
Proposed Rule
Starting Jul. 1, 2025, and on or before every 6 months thereafter, each carrier shall make publicly available and submit to the Division via secure file transfer 3 JSON files.
Files must contain table of contents file, negotiated rates for all covered items and services between carrier and in-network providers in accordance with requirements.
And, unique out-of-network allowed amounts, billed charges for covered items furnished by out-of-network providers in accordance with 45 CFR 147.212(b)(I)(ii).
Each carrier and/or PBM shall submit to COL INS via secure file transfer a plan list, eight data files, narrative response regarding prescription drugs, health care spending.
Carriers shall include with each submission information pertaining to the size and contents of each file, where they are located on the carrier’s website and contact email
Carriers may provide data on plans in which they operate as a 3rd party administrator, provided that carriers identify clearly to COL INS when submitting data as 3rd-party.
Consultation
Comments on proposed regulation are due Nov. 8, 2024.
Dec. 2024 COL INS Notice of Hearing
On Dec. 13, 2024, COL INS issued notice of hearing for Jan. 14, 2025, at 10:00 AM.
Written comments may be submitted by 5PM, Jan. 17, 2025, for review, consideration.
