Applicable entity, specified large employer and the spending terms are defined
What the document says“The term `specified large employer' means, in connection with a group health plan (including group health insurance coverage offered in connection with such a plan) established or maintained by a single employer, with respect to a calendar year or a plan year, as applicable, an employer who employed an average of at least 100 employees on business days during the preceding calendar year or plan year”
The new section defines applicable entity to cover group purchasing organizations affiliated with a manager, drug manufacturers, distributors, wholesalers, rebate aggregators, associated third parties, their subsidiaries, parents, affiliates and subcontractors, and others the Secretary specifies. Contracted compensation is ingredient cost plus dispensing fee. Gross spending is figured before rebates and other remuneration and net spending after. A specified large employer averaged at least 100 employees in the prior year, and a specified large plan averaged at least 100 participants. Remuneration is defined by the Secretary through rulemaking and must be reevaluated every five years.
What the document actually says“The term `specified large employer' means, in connection with a group health plan (including group health insurance coverage offered in connection with such a plan) established or maintained by a single employer, with respect to a calendar year or a plan year, as applicable, an employer who employed an average of at least 100 employees on business days during the preceding calendar year or plan year”
A specified large employer is one with 100 workers or more. That is the average count over the work days of the year before.
The line at 100 decides which plans get the long report. Below it, a plan gets the short one. The other terms name who must hand data over.
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