The Compliance Download, September Vol. 2

A New Phase of the No Surprises Act Is Here. Are You Prepared?

What’s the issue: The No Surprises Act’s patient protections remain unchanged, but new federal rules which became effective Aug. 3 are reshaping the payment dispute process between health plans and out-of-network providers.  

Why it matters: For self-funded plans, these changes include new registration requirements, enhanced claim disclosures, stricter timelines, and more structured dispute resolution procedures. Importantly, even when a third-party administrator (TPA) handles day-to-day administration, the plan remains responsible for compliance.  

What to do: 

• Review TPA agreements to clarify responsibilities for IDR disputes, registration, notices, and fee payments; in most cases the TPA/carrier will be responsible though when it comes to the No Surprises Act clarity ensures compliance.  

• Confirm that your TPA is ready to implement new coding, disclosure, and payment notice requirements.   

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How are You Handling the Compliance Implications of Surging Healthcare Costs?

What’s the issue: Cost trend is hitting historic highs; 8.5% in 2026, 9.2% in 2027, and a cumulative 76% increase over the last decade. As you respond with plan design changes, cost-shifting, or vendor changes to manage this trend, each of those levers carries its own compliance trigger: ERISA plan document and SPD amendments, ACA affordability recalculations, mental health parity (MHPAEA) comparative analyses, and COBRA rate updates all move when the plan moves. 

Why it matters: Cost pressure is forcing decisions faster than most compliance calendars are built to handle. If you reduce benefits or shift cost to employees without a documented process, you’re exposed on two fronts: fiduciary liability for decisions that aren’t demonstrably in participants’ interest, and regulatory exposure if required notices, filings, or analyses don’t keep pace with the change. Plan sponsors are being held to the same fiduciary standard regardless of how fast the underlying cost environment is moving. 

What to do: 

• Document the fiduciary process, not just the decision. For any plan design change, keep a written record of the alternatives considered, the data reviewed (claims experience, benchmarking, actuarial projections), and why the chosen option serves participants. 

• Recheck ACA affordability thresholds if you’re raising employee contributions; confirm the change doesn’t push any coverage tier over the indexed affordability percentage for the plan year, which would expose you to employer shared responsibility penalties. 

• Update plan documents and SPDs/SMMs on the required timeline. Material modifications generally require an SMM within 210 days after the plan year ends (or 60 days for material reductions in group health coverage). Track this trigger the moment a benefit change is approved, not when open enrollment starts. 

• Refresh COBRA rate calculations and vendor notices any time premium equivalents change, and confirm your COBRA administrator’s systems reflect the new rates before the next qualifying event. 

• Audit data-sharing terms in any new or renegotiated vendor contract (TPA, PBM, stop-loss) for HIPAA business associate agreement compliance and breach notification obligations.  

• Communicate changes through channels that satisfy disclosure requirements, not just convenience. Required notices (SBC updates, SMMs, COBRA rate notices) have specific delivery and timing rules that a general employee email doesn’t necessarily satisfy. 

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