Navigating the complex and ever-evolving world of health plan compliance is a critical challenge for any business. As we step into 2024, several key issues and regulatory changes demand our attention to ensure our health plans are not just compliant but also effectively serve our employees’ needs.
- Enhanced Transparency Requirements: The upcoming year places a stronger emphasis on transparency in health plans. This includes a significant expansion of the cost comparison tool, which now must cover all covered items, services, and drugs. Additionally, there’s an increased focus on providing machine-readable files (MRFs) and detailed reports on prescription drug spending. As business leaders, it’s crucial to ensure that your service providers are compliant with these requirements.
- Mental Health Parity and Addiction Equity Act (MHPAEA) Enforcement: The MHPAEA continues to be a focal point, especially regarding nonquantitative treatment limitations (NQTLs). There’s a proposed rule from August 2023 which could bring extensive changes to MHPAEA’s requirements. Keeping a close eye on this and ensuring your health plans align with these standards is vital.
- Preventive Care Coverage Mandates: The Affordable Care Act’s (ACA) mandates for preventive care coverage, including COVID-19 related changes and possible expansion of contraceptive coverage, will see ongoing developments. It’s important to stay updated with these changes to ensure your health plans remain in compliance.
- Electronic Reporting Under ACA: The threshold for ACA electronic reporting has been lowered, calling for a more digital approach in how we manage and report our health plan data. This shift requires a proactive approach to adapt to the electronic reporting landscape.
- State and Federal Legislative Changes: 2024 may bring new regulations at both state and federal levels, impacting areas like pharmacy benefit managers (PBMs) and other aspects of health plan management. Keeping an eye on these potential changes will help in adjusting your plans accordingly.
- Telehealth and High Deductible Health Plans (HDHPs): The CARES Act’s telehealth exceptions for HDHPs, currently extended to 2025, may undergo further changes. It’s crucial to monitor these developments to ensure your health plans remain compliant and beneficial for your employees.
The landscape of health plan compliance in 2024 is marked by a mix of ongoing trends and new developments. Staying informed and proactive is key to navigating these changes successfully. For a more in-depth understanding of these compliance issues and how they affect your business, refer to the links below:
Top Health Plan Compliance Issues for 2024
2024 Small Group Compliance Calendar
2024 Large Group Compliance Calendar
We are in this together – let’s make 2024 a year of informed decisions and strategic planning in health plan management.
