Updated Guidance Regarding No Surprises Act Prescription Drug Reporting and Wellness Program Costs

Employee Benefits

Updated Guidance Regarding No Surprises Act Prescription Drug Reporting and Wellness Program Costs

We previously authored an article about the requirement to report certain wellness costs under the No Surprises Act’s prescription drug reporting requirement. The article provided in-depth information on the regulations’ requirement to report on wellness spending, as detailed in the then-current CMS Prescription Drug Data Collection (RxDC) Reporting Instructions.

Since we first wrote the article on the wellness cost reporting requirement, CMS released revised Prescription Drug Data Collection (RxDC) Reporting Instructions, which are available here. The new instructions reduce the ambiguity in the prior instructions regarding the wellness program reporting and significantly limit the scope of the wellness costs that need to be reported.

The updated instructions now provide that only “wellness services billed on a claim” need to be included in the “other medical costs and services” reporting category and specifically exclude “wellness services that are not covered services under a plan or policy.” The instructions provide that for reporting purposes, “wellness services are defined as activities primarily designed to implement, promote, and improve health.”

Because the instructions do not further define the term “wellness services,” we cannot opine on whether they are intended to include each and every service covered by a medical plan which promotes and improves health and wellness and which are billed to the medical plan on a claim.

Regulatory and Legislative Strategy Group

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