The Compliance Toolkit first quarterly update addresses:
The Independent Dispute Resolution section was updated to include a section for the Revenue Procedure 2022-11 which published the percentage adjustment for median contracted rates.
The Pharmacy Benefit and Drug Cost Reporting section was updated to include a section reflecting the guidance contained in the November 23, 2021 Prescription Drug and Health Care Spending Interim Final Rules, implementing Section 204, Title II, another phase of the transparency provisions of the Consolidated Appropriations Act (CAA) of 2021.
The Direct and Indirect Compensation section was updated to reflect clarifying language and a section was added to address guidance contained in the Field Assistance Bulletin No. 2021-03 released by the Department of Labor (“DOL”) on December 30, 2021.
Attachment 1: Compliance Tool – CAA and Transparency Financial Impact Analysis Tool was updated to reflect additional calculations.
Attachment 9: Compliance Tool – MHPAEA Comparative and Fee Analysis Tool was updated to improve some of the functionality.
Compliance Toolkit Second Quarterly Update
The Compliance Toolkit second quarterly update addresses:
The Initiation of IDR Process section was updated to indicate that online IDR portal was opened on April 15, 2022.
The Determination of Payment section was updated to report a court case that invalidated the portion of the interim final rule relating to the presumption that the QPA is the most appropriate amount and a release of a Memorandum, withdrawing the portion of the interim final rule that was invalidated by the court.
The Petition to Deny or Revoke IDR Certification was updated to report the release of IRS Notice 2022-11, which provides guidance on indexing “the qualifying payment” amount for items and services furnished in 2022 in the case of a group health plan or insurer that does not have enough information as of January 31, 2019, to calculate the median of the in-network contracted rates or in the case there are new items or services being furnished.
The Fee Disclosure Related to Covered Group Health Plans Section was updated to remove duplicate sections.
The Public Disclosure of Provider Fees Requirement section was updated to report the release of two new FAQs discussing the machine-readable files used for public disclosure.
Compliance Toolkit Third Quarterly Update
The Compliance Toolkit third quarterly update addresses:
The “Independent Dispute Resolution (IDR) Procedures for Determining Certain Out-of-Network Rates to Be Paid by Group Health Plans” section has been updated to reflect the following:
Departments jointly issued FAQ guidance adopting an enforcement safe harbor for health plans and insurers reporting certain types of in-network rates under the transparency in coverage.
Departments jointly issued revised process guides for independent dispute resolution (IDR) under the No Surprises Act.
Federal Court stays proceeding in case vacating Portions of No Surprises Act’s IDR Regulations
Departments Jointly issued Checklist for Surprise Billing IDR Process
Departments Issued Checklist for Surprises Billing IDR process
The “Public Disclosure of Provider Fees Requirement” section was updated to clarify that the deadline for posting the Machine Readable Files is July 1, 2022.
Compliance Toolkit Fourth Quarterly Update
The Compliance Toolkit fourth quarterly update addresses:
Federal Court vacated key portions of the interim final regulation implementing the independent dispute (IDR) provisions of the No Surprises Act relating to air ambulance services.
The DOL, HHS and IRS finalized options of the No Surprise Act medical billing regulation covering the independent dispute resolution (IDR) process. These regulations first remove the provision that the court invalided and specify that certified IDR entities should select the offer that represents the value of the item or service under dispute after considering the QPA and all permissible information submitted by the parties. The regulation net expanded on the requirement that health plans and insurers disclosure to provided and facilities the QPA for items or services with each initial payment or notice of denial of payment.
In connection with the release of the final Surprise Billing regulations, the Departments of Labor (“DOL”), Health and Human Services (“HHS”) and Treasury (collectively, the “Agencies”) released an extensive set of FAQs covering surprise billing and price transparency rules. The FAQs are wide-ranging, but provide important clarifications.
CMS published more detailed reporting guidance along with reporting templates on its RxDC webpage for Prescription Drug reporting due on December 27, 2022. This guidance included the following:
RxDC reporting instructions
RxDC templates
RxDC drug name and therapeutic class crosswalk
CMS also revised the Model Disclosure Notice Regarding Patient Protections Against Surprise Billing and its instructions and the Standard Notice and Consent Documents Under the No Surprises Act to be used in 2022 and to be used in 2022 and beyond.
Attachment 2 now reflects the recently released revised “Model Disclosure Notice Regarding Patient Protections Against Surprise Billing.”
Attachment 3 now reflects the recently released revised “Standard Notice and Consent Documents Under the No Surprises Act.”
Compliance Toolkit Contents
To address the compliance needs of the industry, Humaculture, Inc. partnered with Attorneys Howard Lapin and Larry Grudzien to create a Compliance Toolkit to address all of the requirements in the new law and regulations. It contains over forty documents, including:
A detailed explanation of the law and regulations;
A compliance tool that highlights all of the required changes and what steps needed to be taken to comply;
Sample provisions for plan documents, Summary Plan Descriptions, and administrative services agreements;
All of the model notices that have to be provided to covered individuals;
Sample notices that have to be provided to participants; and
Sample disclosures and reports that have to be made to the governmental agencies.
There are over two hundred and eighty-five (285) pages of documents in this Compliance Toolkit. It has been specially designed for use by employers, insurers, brokers, and third-party administrator to help them effectively to comply with all of the requirements.
Webinar Reviewing the Compliance Toolkit
On December 14, 2021, we conducted a free webinar to review the Compliance Toolkit. We reviewed its contents and explained how it can be used to comply with the requirements. You can view the webinar here.
Hidden Opportunities, A Strategic Compliance Series
Humaculture, Inc. conducted a strategic compliance webinar series over the first five months of 2022 focusing on harnessing the Hidden Opportunities in the No Surprises Act and Transparency in Coverage Final Rule. Our goal was to help organizations create a competitive advantage. Does it make sense to expend limited resources to merely comply with the law and regulations, or is there a way to strategically “design the compliance away” while strategically differentiating the employee value proposition?
Ordering
You can purchase the Compliance Toolkit, which includes quarterly updates through October 31, 2023, for only $450 by contacting us and we will invoice you for the purchase price. Contact us to order your own copy or to ask any questions.
Available Support
We are available to support you in your compliance and financial needs. This Compliance Toolkit, including Financial Analysis Tools will help facilitate self compliance. Our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are also available to guide you through the compliance process, or we can take the lead. We would be happy to have a conversation regarding your needs and can customize a proposal for the level and type of support you may need. Please contact us.
Watch a replay of the third webinar in Humaculture, Inc.’s “People Development: A Humaculture® Perspective Series” to learn how to conduct Career Planning to support employee development, and why “Effective Pruning Bears Fruit” by building employee capabilities.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Christi Green, RN, MS, PHR, strategy and people consultant
Employee Development Objective
We’ve talked about how to “Walk the Garden” to assess employees as well as help them develop capabilities to align with the organization’s vision, mission, and values. Now this webinar focuses on how to activate and inspire our workplace AND workforce to further grow and develop employees. Research is abundantly clear that engaged employees help organizations succeed and bear fruit. There is no silver bullet to increase retention/reduce turnover. However, we do believe that investing in the organizational soil and the culture to nurture and support people will bear the fruits of success!
Career Planning: Employee Development Key Takeaways
During this session, participants will learn that:
Organizations sometimes fall into the “warm body syndrome” trap
Unhealthy/misaligned cultures disrupt employee development efforts
Career planning tends to only occur only for a select few
For effective employee development organizations must:
Hire and develop intentionally to fulfill the vision, mission, values
“Prune” to focus growth as well as direct energy and effort
“Trellis and irrigate” to support desired growth
Prepare for appropriate transitions
Available Support
We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].
Watch
Watch the Career Planning: Effective Pruning Bears Fruit: Employee Development Webinar Replay below, or via Rumble or YouTube.
Join us on Thursday, November 17 from 12:00 to 12:30 CDT for the third webinar in Humaculture, Inc.’s “People Development: A Humaculture® Perspective Series.” You will learn how to conduct Career Planning to support employee development, and why “Effective Pruning Bears Fruit” by building employee capabilities.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Christi Green, RN, MS, PHR, strategy and people consultant
Objective
We’ve talked about how to “Walk the Garden” to assess employees as well as help them develop capabilities to align with the organization’s vision, mission, and values. Now it’s time to talk about how to activate and inspire our workplace AND workforce to further grow and develop employees. Research is abundantly clear that engaged employees help organizations succeed and bear fruit. There is no silver bullet to increase retention/reduce turnover. However, we do believe that investing in the organizational soil and the culture to nurture and support people will bear the fruits of success!
Career Planning: Employee Development Key Takeaways
During this session, participants will learn that:
Organizations sometimes fall into the “warm body syndrome” trap
Unhealthy/misaligned cultures disrupt employee development efforts
Career planning tends to only occur only for a select few
For effective employee development organizations must:
Hire and develop intentionally to fulfill the vision, mission, values
“Prune” to focus growth as well as direct energy and effort
Watch a replay of the second webinar in Humaculture, Inc.’s “People Development: A Humaculture® Perspective Series”, to learn how to shape talent for success by “Pruning the Vines,” using capabilities to prune to encourage growth so employees to fulfill their potential and maximize alignment and productivity.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Christi Green, RN, MS, PHR, strategy and people consultant
Prune to Encourage Growth Objective
This webinar explores ways organizations can “Prune to Encourage Growth” to shape talent for the future. Capabilities can be used to help organizations select the best plants, determine how best to organize them in the garden, identify strengths and weaknesses, prune away distractions (weak branches) to encourage growth and fruit production.
Key Takeaways
During this session, participants will learn that:
Competencies tend to be just a checklist of skills to manage
People that focus on everything may not be very good at anything
Highly skilled employees may not thrive in management or leadership
Effective people development:
Is rooted in a clear understanding of organizational vision
Assesses skills and needs to support strategic priorities
Explores the employee’s interests, abilities, and desires
Identifies potential for transitions, management, or leadership
Applies principles that work
Available Support
We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].
Watch
Watch the Shaping Talent for Success: Pruning the Vines – Capabilities: Prune to Encourage Growth Webinar Replay below, or via Rumble or YouTube.
Join us on Thursday, August 18 from 12:00 to 12:30 CDT for the second webinar in Humaculture, Inc.’s “People Development: A Humaculture® Perspective Series”, to learn how to shape talent for success by “Pruning the Vines,” using competencies to encourage growth in employees to fulfill their potential and maximize alignment and productivity.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Christi Green, RN, MS, PHR, strategy and people consultant
Objective
This webinar explores ways organizations can shape talent for the future. Competencies can be used to help organizations select the best plants, determine how best to organize them in the garden, identify strengths and weaknesses, prune away distractions (weak branches) to encourage growth and fruit production.
Key Takeaways
During this session, participants will learn that:
Competencies are not just a checklist of skills to manage
People that focus on everything may not be very good at anything
Highly skilled employees may not thrive in management or leadership
Effective people development:
Is rooted in a clear understanding of organizational vision
Watch a replay of the first webinar in Humaculture, Inc.’s “People Development: A Humaculture® Perspective Series”, which focuses on how to “Walk the Garden” to build employee relationships, enhance culture, and improve productivity. We discuss transforming your performance management process into one that focuses on facilitating growth and productivity.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Christi Green, RN, MS, PHR, strategy and people consultant
Objective
This webinar explores ways organizations can shift traditional performance management from the dreaded once-a-year process that is focused on past performance into an on-going discussion. “Walking the Garden” builds strong relationships, keeps people aligned with the culture, helps identify issues early that may inhibit productivity, facilitates growth, prepares your next generation of leaders, and identifies opportunities for transition. This requires proper job design to ensure employees are “planted in fertile soil.”
Key Takeaways
During this session, participants will explore:
The pitfalls of trying to “manage performance”
Why traditional “performance management” is a dreaded process, often detrimental to employee relationships, culture, and productivity
How manager job design and span of control may limit effectiveness
How effective people development will:
Shift from “managing performance” to facilitating growth
Help managers and leaders learn to “walk the garden”
Lead to better alignment between employees’ personal/professional goals and the organization’s strategic priorities
Available Support
We are available to support you in your strategy, design, compliance, financial, and monitoring needs. Our team includes business and human relations leaders, finance experts, actuaries, clinicians, behavioral health experts, pharmacy experts, and legal resources to guide you through the strategy and compliance process. Please contact us: [email protected].
Watch
Watch the Performance Management: Walking the Garden – Shift from Managing to Facilitating Growth Webinar Replay below, or via Rumble or YouTube.
Join us on Thursday, June 16 from 12:00 to 12:30 CDT for the first webinar in Humaculture, Inc.’s “People Development: A Humaculture® Perspective Series”, to learn how to “Walk the Garden” to build employee relationships, enhance culture, and improve productivity.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Christi Green, RN, MS, PHR, strategy and people consultant
Objective
This webinar explores ways organizations can shift traditional performance management from the dreaded once-a-year process that is focused on past performance into an on-going discussion. “Walking the Garden” builds strong relationships, keeps people aligned with the culture, helps identify issues early that may inhibit productivity, facilitates growth, prepares your next generation of leaders, and identifies opportunities for transition. This requires proper job design to ensure employees are “planted in fertile soil.”
Key Takeaways
During this session, participants will learn that:
The problems and misnomer of trying to “manage performance”
Why traditional performance management is a dreaded process, often detrimental to employee relationships, culture, and productivity
How manager job design and span of control may limit effective focus
Effective people development will:
Shift from “managing performance” to facilitating growth
Help managers and leaders learn to “walk the garden”
Encourage growth in a specific direction
Lead to better alignment between employees’ personal/professional goals and the organization’s strategic priorities
Please join us on the third Thursday of the month over the next six months for our upcoming People Development series. This series will focus on how to shape talent for success by “pruning the vines” as necessary. We will cover people development from the Humaculture® perspective.
In this webinar series, we explore ways organizations can rethink the traditional performance management and people development processes to make them more meaningful, impactful, and aligned with the organizational vision and strategy – focusing employees and leaders on what is truly important.
Successful horticulturists recognize the overwhelmingly positive impact of pruning. Pruning is the process of removing branches that:
Are not supporting the desired shape of the plant the horticulturist seeks,
Take energy from the plant without maximizing productivity,
Shade or otherwise interfere with the productivity of the other branches.
Effective pruning allows the plant to focus its energies in the most effective and productive areas. People, like plants, often expend energy and time in areas that distract them from achieving their highest and greatest purpose and contributions. In any organization, it is important to help employees remove or overcome the impediments that hold them back, and focus on the areas and interests that will really help them achieve their goals, as well as the strategic priorities of the organization. This series highlights several ways organizations can be innovative and more effective than traditional “performance management.”
To view our prior Strategic Compliance series on the Hidden Opportunities within the CAA and Transparency Rules, click here.
Available Support
We are available to support you in your strategy, design, compliance, financial, and monitoring needs. To that end, our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are available to guide you through the compliance process. Please contact us.
Watch a replay of the fifth webinar in Humaculture, Inc.’s Hidden Opportunities, Strategic Compliance Series, which focuses on how to use fee disclosure to leverage behavioral design, seek strategic advisors, and optimize plan efficiency.
Steve Cyboran, ASA, MAAA, FCA, CEBS, actuary and strategy consultant
Wes Rogers, Humaculturist® and strategy consultant
Jack Towarnicky, LLM, JD, MBA, CEBS, attorney, strategy and compliance consultant
Objective
Beyond basic compliance, this series addresses how to strategically leverage the No Surprises Act and Transparency in Coverage to create a competitive advantage for both the employer and employees. This session focuses on how leveraging Fee Disclosure as a means of “Pest Management” to leverage behavioral design to align interests with your advisors to take a strategic approach and identify conflicts of interest and inferior value in services provided.
Fee Disclosure Key Takeaways
During this session, participants will learn that:
It seems Congress doesn’t believe group health plan fiduciaries are knowledgeable about fees
This may be a first step to shine light on fee reasonableness, conflicts of interest
While the plan fiduciary remains responsible, advisors are put on notice to disclose
Mere compliance ignores the opportunity to cultivate the organizational soil
Leveraging Fee Disclosure as a means of “Pest Management” can:
Identify conflicts of interest and inferior value in services provided
Avoid advisors who haven’t already fully disclosed their compensation
Seek advisors who take a strategic approach, cultivate your organizational soil
Employ behavioral design to align interests
Available Support
We are available to support you in your strategy, design, compliance, financial, and monitoring needs. To that end, our team of consultants, including actuaries, clinicians, behavioral health, pharmacy, and legal resources are available to guide you through the strategy and compliance process. Please contact us: [email protected].
Watch
Watch the Hidden Opportunities: Pest Management, Minimizing Plan Losses through Fee Disclosure Webinar Replay below, or via Rumble or YouTube.
