Understanding the regulatory healthcare reforms in setting the health insurance legislation becoming inevitable in the insurance industry. With the changes in the technology and demand of the patients, the insurance regulatory framework does undergo some major changes for setting customer-centric health insurance policies. As the Insurance regulatory framework keeps changing with time, keeping with healthcare policy updates is the key to insurance compliance rules.
As more and more transformation is taking place regarding claim settlements and deductions, the need for complete knowledge about health insurance legislation is visible in the healthcare industry. To help you keep up with the recent Health insurance Legislation and Regulatory Changes that are impacting healthcare insurance, this guide covers the top 5 healthcare policy updates that are gaining traction this year. So, without any delay, let us get inside and learn the recent updates on the insurance regulatory framework.
Check Out The Top 5 Health Insurance Legislation Shaping The Healthcare
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Price Transparency Requirements
The first on the list of top 5 Health Insurance Legislation and Regulatory Changes noticeable in 2024 comes the price transparency requirements. Price transparency requirements are visible in today’s time. The Transparency in Coverage Act that was implemented in the year 2020 calls for mandatory insurance compliance. That means all insurance companies irrespective of the size and scalability are required to share pricing data for all products and services falling under in-network and out-of-network providers.
Not just that, the entire data covering the pricing details must be available in a computer-readable format called Machine-Readable Files and must be easy to access free of cost. Further, citing the price transparency requirements, the Centers for Medicare & Medicaid Services (CMS) in the year 2023 stated that the cost-sharing information must also be available to predict the policy impact on healthcare costs.
Hence, by January 1, 2024, insurance companies are bound to comply with these healthcare reforms and correctly schedule the price transparency reports for analyzing the policy impact on healthcare costs.
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Medicare Advantage Regulations
The second among the top 5 Health Insurance Legislation and Regulatory Changes noticeable in 2024 comes the Medicare Advantage Regulations. According to the Centers for Medicare & Medicaid Services (CMS) citing the insurance regulatory framework Medicare Advantage regulations are mandatory. It can not only improve health equity, but also create person-centered care, and Medicare affordability. These rules include changes to payment rates, Part C and Part D policies, and Star Ratings.
According to the recent insurance regulatory framework, the Star Ratings in the Medicare Advantage plans are very important in insurance plans because they are linked to bonuses and incentives from CMS. These ratings show the quality of care a particular health insurance plan provides. It includes patients’ experiences with the plans. By increasing the importance of member experience through Medicare Advantage Regulations, CMS is pushing insurers to improve how they treat members.
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Drug Pricing Transparency
The third big change on the list of the top 5 Health Insurance Legislation and Regulatory Changes noticeable in 2024 comes the Drug Pricing Transparency.
The Department of Health and Human Services has picked ten drug companies for Medicare price negotiation. Falling under one of the major recent healthcare policy updates in the insurance compliance laws, Drug Pricing Transparency will undergo some major changes. As a result, this will ease the analysis of the insurance policy’s impact on healthcare costs. Though there was some pushback among the companies, still all ten drug companies agreed to the negotiations. However, you need to watch out for the amendments in the insurance regulatory framework until September 2024.
The new drug prices will be announced by the CMS by September and the same will take effect in January 2026. Also, citing the CMS healthcare reforms, 48 Part B drugs might get rebates because their prices were raised faster than inflation. This means that people taking these drugs will pay less in coinsurance. Thus, you will save between $1 and $2,786 per dose.
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Mental Health Coverage Mandates
The next major changes noticeable in the Health Insurance Legislation and Regulatory Changes in 2024 that will impact health insurance comes the Mental Health Coverage Mandates. Yes, in the coming times, every health insurance plan must abide by the mental health coverage mandates. Also, the new rules set by the insurance regulatory framework aim to improve mental health insurance by reducing costs for patients and increasing access to mental health and substance abuse services.
The goal is ultimately to make mental health coverage equal to physical health coverage. This is called parity. Parity means that mental health services should have the same benefits and limits as physical health services, with no extra restrictions like visit limits or higher deductibles. This change will help more people get the mental health care they need without extra financial burdens.
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Telehealth Policy Extensions
The last major change noticeable in the Health Insurance Legislation and Regulatory Changes in 2024 that will impact health insurance comes the Telehealth Policy Extensions. In the coming times, telehealth policy extensions will also see tremendous growth in health insurance plans. Currently, every healthcare reform taking place is focusing on making telehealth accessible while ensuring quality care.
Citing the above, dated in May 2024, the House Committee on Ways & Means introduced a new law called the Preserving Telehealth, Hospital and Ambulance Access Act. This law aims to extend Medicare telehealth services until the year 2026. It allows telehealth visits from anywhere, delays the need for in-person visits for mental health, and extends audio-only telehealth. It also includes a five-year extension for the Hospital at Home program.
Key parts of the Telehealth Policy Extensions include:
- Focus on removing the restrictions on where telehealth services can be provided.
- Major focus on expanding the types of providers who can offer telehealth.
- A major focus for expanding telehealth services.
- The need for extending the provision of mental health telehealth services will rise in rural health clinics.
- Delaying the need for face-to-face visits for mental health telehealth services.
- Sustaining the capability to charge for telehealth services that are audio-only.
Final Words
In conclusion, the health insurance legislation constantly undergoes some significant transformations in the health insurance. Therefore, insurance compliance by the companies for the ongoing healthcare reforms is mandatory. The above-mentioned insurance regulatory frameworks are some of the top healthcare policy updates that require a clear understanding in today’s time.
Whether you consider price transparency, Medicare Advantage regulations, drug pricing transparency, or mental health coverage mandates, the ultimate goal of health insurance companies should be to provide patient-centric and equitable healthcare solutions.
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FAQs
- What are the new price transparency requirements for health insurance in 2024?
Ans. Every health insurance company will be required to disclose pricing information for all products and services offered by both in-network and out-of-network providers.
- How will the Medicare Advantage Regulations change in 2024?
Ans. In 2024, the Medicare Advantage Regulations will prioritize enhancing health equality, establishing patient-focused care, and enhancing Medicare accessibility.
- What is the purpose of the Mental Health Coverage Mandates in 2024?
Ans. The Mental Health Coverage Mandates aim to make mental health coverage equal to physical health coverage. This means that mental health services will have the same benefits and limits as physical health services, with no additional restrictions like visit limits or higher deductibles.
