America's Benefit Specialist March 2023

NABIP’s LEGISLATIVE PRIORITIES

allowing for first-dollar coverage of COVID-19 testing and treatment under a high-deductible health plan, and treat ing health expenses as an employment expense under the employee retention tax credit. These provisions have begun a path toward lowering the cost of healthcare that this Con gress should build upon to provide employers with the ability to enhance employee coverage permanently. NABIP also urges action on bipartisan legislation to increase affordable options for patients and employers. Be cause the cost of care has increased, health-plan deductibles have also increased in an effort to keep the cost of coverage affordable. Many of the most creative plan designs allow access to primary care before the deductible has been met to ensure that covered individuals can get the coverage they need early before their condition becomes more severe. Un fortunately, these innovative plan designs don’t qualify to be paired with a Health Savings Account, which would be a very cost-effective way for covered individuals to pay for out-of pocket expenses. HSAs were created nearly 20 years ago, but regulations that define a qualified high-deductible health plan that can be used with an HSA have not kept pace in today’s changing benefits landscape. Modernize the definition of an HSA-qualified high- deductible health plan to allow primary care visits before application of the plan deductible. PROTECT MEDICARE BENEFICIARIES FROM PREDATORY MARKETING New Medicare marketing regulations, which officially went into effect on October 1, made significant changes to existing marketing requirements for both Medicare Advantage and Part D plan-marketing requirements that NABIP believes will be ineffective and place consumers in the hands of those entities CMS is trying to protect them from. The regulation seeks to account for unscrupulous marketing behaviors by requiring third party marketing organizations (TPMOs) to record all enrollment conversations. The final rule’s definition of TPMO, however, is overly broad and includes independent Medicare agents and brokers, needlessly impacting agents who are acting responsibly. NABIP supports legislation to explicitly exclude indepen dent agents and brokers from the current requirement to record calls with beneficiaries, in addition to any future regulations that relate to recording calls with beneficia ries. NABIP recognizes the increase in unscrupulous actors in the Medicare market; however, the CMS regulations re leased last year do not adequately address these entities and inappropriately target licensed and certified agents and brokers committed to acting in the best interest of Medicare beneficiaries. For more information about our legislative priorities, visit www.nabip.org/advocacy.

4 There is a delay in the Consolidated Appropriations Act (CAA) Transparency in Coverage (TiC) require ments that machine-readable files be released by plan sponsors to indicate in- and out-of-network costs of care. NABIP advocated for a delay because plan spon sors would not have been able to comply with the law without further guidance beyond what was included in the CAA. • NABIP subsequently requested and received TiC guidance on allowing carriers to post ma chine-readable files for plan sponsors with specific rules for fully funded versus self-funded plans. This lifted a huge burden from some plan sponsors that were struggling with compliance without the assis tance of a carrier. 4 NABIP was successful in receiving a delay in the CAA’s prescription drug-reporting requirements accompanied by specific reporting standards and definitions, including identifying prescription drugs regardless of the dosage strength, package size or mode of delivery. Additionally, the guidance clarified the role of the PBM, requiring PBMs to provide any information they have on the top 25 drugs generating the highest rebate amounts. 4 NABIP won a long-fought victory when CMS released a new FAQ document that clarified that a health insur ance issuer cannot treat commissions on individual en rollments during a special enrollment period differently than commissions on enrollments during the open- enrollment period. 4 Since the inception of the ACA, NABIP has advocated for a fix of the “family glitch.” The Biden administration released a final rule to do just that, but also responded adding a section that directly addressed NABIP’s con cerns about a potential conflict between the affordability rules and the cafeteria plan rules by issuing guidance in IRS Notice 2022-41, which permits employers to amend their Section 125 plans to allow eligible dependents to drop their group coverage midyear in favor of subsidized individual exchange coverage. 4 NABIP continues to advocate for changes to the CMS Medicare Marketing Rule. NABIP was successful in re questing CMS to provide official written clarification on several questions that NABIP and our members have posed to the agency since the rule became final. 4 With NABIP’s support, CMS altered the timeline for Medicare coverage eligibility. Under the final rule, Medicare coverage would become effective the month after enrollment for individuals enrolling in the last three months of their initial enrollment period, thereby reducing any potential gaps in coverage.

benefitspecialistmagazine.com | ABS 11