State All-Payer Claims Database Reporting 

Several states have laws requiring third-party administrators (TPAs), health insurers and other entities to report healthcare eligibility and claims data to the state’s All-Payer Claims Database (APCD). The information collected by the APCD is generally intended to help improve health care quality, reduce costs, and promote transparency. However, requirements vary from state to state, with each taking a different approach to the purpose and structure of APCDs.   

Many states require TPAs and insurers who act as TPAs to report data on self-insured ERISA health plans. Due to ERISA preemption considerations, some insurers and TPAs may ask self-insured plans for consent or provide an option to opt out of having their data included. 

Client Action: If you receive a request from your insurer or TPA in regard to APCD reporting and have questions, your client service team is available to assist you. 

What We’re Watching 

• White House Executive Order regarding health care price transparency 

• Reintroduction of bipartisan Telehealth bill 

• Concerns over the implementation of Florida’s Prescription Drug Reform Act 

Advancing Health Care Price Transparency 

On February 25, the White House issued an Executive Order (EO) aimed at revitalizing efforts to enhance health care price transparency. The directive builds on previous initiatives, including EO 13877 from the first Trump administration. 

Specifically, the new EO directs the Departments of Treasury, Labor (DOL), and Health and Human Services (HHS) to take the following actions within 90 days: 

• Require disclosure of the actual prices of items and services, not just estimates 

• Issue updated guidance or proposed regulations to ensure pricing information is standardized and easily comparable across hospitals and health plans 

• Issue guidance or proposed regulations updating enforcement policies to ensure compliance with transparent reporting of complete, accurate, and meaningful data 

The EO also directs agencies to identify additional opportunities to empower patients with meaningful price information and expand existing transparency requirements. 

Exactly how the EO will be implemented remains to be seen. We will continue to monitor and provide updates as new guidance or regulations are issued. 

  

Bipartisan Telehealth Bill Reintroduced   

On February 27, the bipartisan Telehealth Expansion Act was reintroduced in the U.S. Senate and House of Representatives. This legislation seeks to permanently allow HSA-eligible health plans to offer telehealth services on a pre-deductible basis. 

This flexibility was originally introduced under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and was subsequently extended through 2024. However, as reported in a previous Piper Jordan alert, the provision expired on January 1, 2025, after Congress failed to pass a further extension.  Although the 2025 Continuing Appropriations and Extensions Act did extend certain telehealth options for Medicare through September 30, 2025, it did not address extension of the telehealth HDHP safe harbor.  

We will continue to monitor the progress of this bill. 

  

American Benefit Council Raises Concerns Over Florida PBM Law 

Florida’s Prescription Drug Reform Act, which took effect on January 1, 2024, governs the licensure of pharmacy benefit managers (PBMs) in the state. 

As part of recent implementation efforts, the Florida Office of Insurance Regulation (FLOIR) has requested that PBMs provide detailed claims and personal health information for pharmacy claims submitted in calendar year 2024. 

This request applies to claims for all individuals residing or employed in Florida, including those covered by self-insured ERISA plans. The FLOIR has requested 47 distinct data elements including patient name, date of birth, and drug prescribed. 

The American Benefit Council has raised significant concerns with FLOIR regarding: 

• ERISA preemption provisions 

• Privacy and security risks under HIPAA 

The Council requested that the FLOIR withdraw the data requests in their entirety, and/or clarify that the scope of the data request does not apply with respect to self-insured, ERISA-covered plans. 

We will continue to monitor this situation and report on any new developments.