In the dynamic world of employee benefits, health plan compliance is vital for employers. As we enter 2024, it’s crucial to understand and deal with the top compliance issues affecting health plans.
Tackling these issues head-on ensures a win-win situation: legal peace of mind and happier, healthier employees. Let’s look closer at each of these areas to understand their significance and implications.
New Rules About Transparency
Transparency in healthcare has emerged as a key focus area. The goal is to empower consumers with information about healthcare costs and quality.
In 2024, group health plans and insurance companies face a variety of transparency requirements. These rules include things like providing easy-to-read files, machine-readable files (MRFs), and cost comparison tools. These tools enable individuals to make informed decisions about their healthcare choices.
Employers must ensure that their agreements with service providers cover these obligations and otherwise follow federal rules on transparency. More guidance on transparency rules might come in 2024. Employers need to stay informed to avoid potential penalties or legal complications.
Mental Health Parity Compliance
Mental health parity (ensuring mental health care gets the same treatment as other healthcare) is crucial. The Mental Health Parity and Addiction Equity Act (MHPAEA) makes sure mental health and substance use disorder benefits are on par with medical/surgical coverage.
Employers need to compare different limits on mental health care to other healthcare. This helps show they’re following the rules. It’s essential for employers to make sure they’re following the rules to avoid any problems.
Employers can demonstrate rigorous compliance with MHPAEA requirements by conducting comparative analyses of nonquantitative treatment limitations (NQTLs). The government can ask to see these comparisons to ensure employers follow the rules.
Preventive Care Benefits
The Affordable Care Act (ACA) mandates that specific health plans cover preventive care without requiring cost-sharing. As guidelines on preventive care change, employers need to remain current. They must ensure that their health plans align with the latest recommendations.
Additionally, ongoing litigation about the ACA’s preventive care mandate complicates compliance efforts. Employers should closely monitor these legal changes and be prepared to update their health plans accordingly to mitigate potential risks.
Access to contraceptives continues to be a focal point in healthcare. In 2024, the federal government may expand the ACA’s contraceptive coverage mandate to cover more types of contraceptives. The inclusion of over-the-counter (OTC) products could have significant implications.
\Additionally, monitoring developments related to exemptions to the contraceptive coverage mandate is crucial for ensuring compliance with federal regulations. Employers should stay on top of these regulatory changes and update their plans.
Electronic Filing Requirement for ACA Returns
Employers have to report certain health plan information to the government. Although electronic filing of ACA returns has become the standard practice for some, starting in 2024, this reporting must be done electronically for most employers.
Navigating the electronic filing process could be difficult. Getting familiar with the ACA Information Returns (AIR) Program is essential to ensure everything gets submitted on time.
Telehealth and HDHPs
Technology Driven Healthcare services, like video visits with doctors, are becoming more common. They offer greater accessibility and convenience for patients, transforming the healthcare landscape. However, integrating telehealth services with high-deductible health plans (HDHPs) raises unique compliance considerations.
Employers offering HDHPs must ensure these services comply with regulatory requirements, especially concerning Health Savings Account (HSA) eligibility. Laws might change, so employers should continue to monitor them.
Other Possible Changes
In addition to these compliance issues, employers should remain vigilant about other potential developments. This could include the following:
- State and federal oversight of Pharmacy Benefit Managers (PBMs)
- Changes to insurance coverage mandates
- Updates to HIPAA privacy and security rules
Staying informed requires ongoing monitoring. Employers should assess the impact of legislative and regulatory updates and emerging trends. They should be prepared to take the necessary steps to ensure compliance with regulatory requirements.
Navigating health plan compliance in 2024 is a big task. Employers must adopt a proactive and strategic approach. By understanding the key compliance issues and keeping up with any changes, employers can effectively manage their health plans and avoid problems.
Prioritizing compliance does more than mitigate legal risks. It fosters a culture of trust and transparency in the company. Ultimately, it benefits both employers and employees alike.