4.5 minute read
Employers should be aware of the compliance issues impacting their health plan coverage in 2024, including expanded electronic reporting requirements under the ACA and anticipated developments under the Mental Health Parity and Addiction Equity Act (MHPAEA).
New Transparency Requirements
To ensure healthcare transparency and protect consumers from unexpected medical bills, group health plans and issuers must meet some transparency requirements. Employers rely on their issuers, third-party administrators (TPAs), and service providers to fulfill these obligations. This includes providing machine readable files (MRFs), a cost comparison tool, and comprehensive reports on prescription drug spending. Employers should regularly update agreements with providers to address compliance and monitor adherence to federal transparency regulations.
- Cost comparison tool: Starting in 2023, health plans and issuers had to provide an internet-based price comparison tool for 500 items, services, and drugs. In 2024, this tool must cover all items, services, and drugs.
- MRFs: Non-grandfathered health plans and issuers must disclose three MRFs containing information on provider rates, allowed amounts for out-of-network services, billed charges, and prescription drug prices. The enforcement delay for posting the prescription drug file has been lifted, and future guidance will specify compliance timelines.
- Prescription drug reporting: Information about prescription drugs and health care spending must be reported to the federally government annually. The annual deadline is June 1st, covering 2023 data.
- Gag clause attestations: Health plans and issuers must submit an attestation of compliance with the federal prohibition on gag clauses by December 31st each year.
Mental Health Parity Compliance
MHPAEA prevents health plans from imposing less favorable benefit limitations on mental health and substance use disorder (MH/SUD) benefits compared to medical/surgical coverage. The U.S. Department of Labor prioritizes MHPAEA compliance, including nonquantitative treatment limitations (NQTLs). Employers should confirm NQTL analyses, monitor compliance updates, and consider parity requirements when making coverage changes. Proposed changes to MHPAEA would establish additional standards for analysis.
Preventative Care Benefits
The ACA requires health plans to cover preventive care services without cost sharing. This coverage mandate changes annually based on updated guidelines. Health plans should update their preventive care coverage each year. Employers should also be aware of recent developments that may impact their preventive care coverage, including the end of certain COVID-19 coverage requirements, ongoing litigation, and potential expansion of contraceptive coverage by the Biden administration.
Coverage Changes Related to COVID-19
When it comes to COVID-19, there have been changes to the coverage requirements for health plans. While COVID-19 diagnostic tests and related services are no longer covered without cost sharing, health plans are still obligated to cover COVID-19 immunizations without cost sharing. However, it's important for employers to assess how these changes impact their coverage of COVID-19 testing and immunizations for 2024 and ensure that any adjustments are communicated effectively to plan participants.
Ongoing Litigation
In March 2023, the U.S. District Court ruled that certain preventive care coverage requirements violate the U.S. Constitution. The Biden administration has appealed the decision, and for now, health plans must continue to cover the full range of preventive care services required by the ACA. Employers may want to consult with their issuers to assess the impact on health coverage.
Contraceptive Coverage
The ACA preventive care mandate may expand in 2024 to include over-the-counter preventive products. Employers should watch for changes and make necessary adjustments to health plan coverage. The Biden administration also wants to narrow exemptions to contraceptive coverage, potentially affecting employers who rely on moral objections. Monitoring the release of a final rule in 2024 is advised.
Expand Electronic Filing Requirement for ACA Returns
The ACA requires large employers and self-insured employers to report health coverage information to the IRS and individuals. Different forms are used depending on the type of employer. Starting in 2024, paper filing will only be available for employers filing fewer than 10 information returns. Most employers will rely on electronic filing, which can be done through the ACA Information Returns Program. Employers should explore their options for electronic ACA reporting. The deadline for electronic filing is March 31, 2024, or the next business day.
Telehealth and HDHPs
To be eligible for HSA contributions, individuals must not be covered by a health plan that provides benefits before meeting the minimum deductible for an HDHP. Typically, telehealth programs that offer free or reduced-cost medical benefits before meeting the HDHP deductible disqualify HSA eligibility. However, the CARES Act allowed HDHPs to provide telehealth benefits before deductibles were met, effective Jan. 1, 2020. This relief extends until Dec. 31, 2024, for calendar-year plans (and 2025 for non-calendar-year plans). Bipartisan legislation aims to make this telehealth exception permanent, but its outcome is uncertain. Employers offering no-deductible or low-deductible telehealth services should stay informed and make necessary changes to their health plan coverage.
Other Potential Developments
Other possible 2024 developments include new oversight for pharmacy benefit managers, state insurance mandates for health plans, and changes to HIPAA rules.
Download the bulletin for more details.
Additional Resources
Final Rule for lowering threshold for electronic ACA reporting for 2024
Website to submit prescription drug data collection (RxDC) report
Proposed rule from August 2023 on MHPAEA compliance
National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
