Q: Will the Departments take enforcement action against any plan or issuer that makes a good faith effort to comply with the prescription drug and health care spending reporting requirements for 2020 and 2021 data?
A: The Departments of Labor, Health and Human Services, and the Treasury (collectively, the Departments) recognize the significant operational challenges that plans and issuers may have encountered in complying with these reporting requirements, including arranging and coordinating submission of a plan’s or issuer’s data across multiple reporting entities, and accurately classifying, compiling, and validating the required data. In particular, stakeholders have expressed concern that, given the novelty and complexity of the requirements, there may be errors or other issues with the first round of data submissions, despite good faith efforts by plans and issuers.
Accordingly, for the 2020 and 2021 data submissions that are due by December 27, 2022, the Departments will not take enforcement action with respect to any plan or issuer that uses a good faith, reasonable interpretation of the regulations and the Prescription Drug Data Collection (RxDC) Reporting Instructions in making its submission. The Departments are also providing a submission grace period through January 31, 2023, and will not consider a plan or issuer to be out of compliance with these requirements provided that a good faith submission of 2020 and 2021 data is made on or before that date.
In addition, to facilitate the submission process, the Departments are providing the following clarifications and flexibilities for 2020 and 2021 data:
- Multiple submissions by the same reporting entity are allowed.
- Submissions by multiple reporting entities are allowed.
- A reporting entity may aggregate state and market segment data at a less granular level than it uses for total annual spending data.
- Submission of premium and life-years data by email is available for certain group health plans
Reporting on vaccines is optional. - Reporting amounts not applied to the deductible or out-of-pocket maximum is optional.
Visit the Centers for Medicare & Medicaid Services website for the Prescription Drug Data Collection (RxDC) Reporting Instructions and the full text of the FAQ.