Compliance Challenges to Look for in 2023
As we kick off each new year, I always try to look ahead and prep for any challenges or opportunities I may think (or know) lie ahead. What skills should I be sharpening? Are there experts or vendors who can help me accomplish those things I know will be on my yearly map? This gives me the sense that I’m controlling the controllables, while recognizing that a lot will arise that I can’t control.
What about compliance challenges, though? What should you be thinking about in 2023? What should you be looking forward to? Here are a few of my thoughts.
Keep Transparency in Mind
The second round of pharmacy and medical expense reporting will be due as of June 1, 2023. This is happening quickly on the heels of the same report that was due in December. Look for an increasing number of vendors to head into this space to take over the reporting process for self-funded clients as needed. (Of course, carriers and PBMs will report for their fully insured groups.) We also hope for more regulatory comments and clarity on the information gathered.
Cost Transparency Will Make Its Way to Employees
As of January 1, 2023, information on 500 shoppable services must have been made available to plan members via telephone, computer/smartphone, and/or paper for requesting individuals. The information will tell plan members approximately how much any one or more of these services will cost based on deductible, copay, coinsurance, etc.
It Will be a Year of Reporting
Air ambulance reporting is proposed for March 2023. While this doesn’t contain the volume of information that December’s reporting did, it still requires detailed information on claims involving the use of an air ambulance. Congress is looking to get its arms around use and cost of these services, and to learn whether legislation could assist in a more reasonable cost.
The End of the Pandemic?
Has the pandemic ended or are we just needing to learn to live with COVID-19?
There are currently two existing states of emergency governing the waning days of the pandemic — the public health emergency (PHE) declared by the HHS secretary, and the state of emergency declared by the President.
Effective January 11, the PHE has been extended for another 90 days; however, in a letter to state governors, the Biden administration has indicated they will give at least a 60-day notice before this emergency ends. The national emergency declaration is in effect unless terminated by the President, through a joint resolution of Congress, or if the President does not issue a continuation. The notice to continue the emergency has been issued by President Biden to continue beyond March 1, 2022 (as of the date of this blog).
As these emergencies move to a close, anticipate changes in health insurance coverage, costs, and payment for COVID-19 testing, treatment, and vaccinations. Plan documents will need to be updated to respond to the end of other life-event extensions in place. Want to learn more? Sign up for our March Holmes Murphy mini webinar on this topic!
Expect Congress to Tackle Healthcare and Insurance Priorities
The ranking member of Congress on the Senate’s Health, Education, Labor, and Pensions Committee is Bernie Sanders. Expect the iconoclast from Vermont to focus on drug pricing, income inequality, and medical debt. Drug companies are concerned that Sanders might seek to revive policies like importing drugs from Canada and other nations, and lobbyists worry about getting their points across to Sanders.
Employers May Need to Shift Priorities to Maintain Employee Health and Wellbeing
Attracting and retaining employees appears to be more difficult than ever. How do employees really want employers to show they are valued? Money? Time off? Better benefits? And what do better benefits really mean — are they dealing with other forms of insurance, like pet insurance? Are they implementing longer PTO, or better maternity and paternity leave? Is it making employee benefits easier to access via apps that are available 24-hours-a-day? The challenge is going to be to determine what your specific workforce values, and then see whether you can create an employee benefits package that addresses those needs.
Expect Mental Health to Remain Front and Center
We all learned during the pandemic that employees wanted greater access to mental health services. The Consolidated Appropriations Act of 2021 required even more from employers in the form of an analysis on the sufficiency of their health plan’s mental health benefits when compared to the plan’s medical and surgical benefits.
Employers should expect to see more requests for these analyses in 2023 and beyond. Insurance carriers and third-party administrators (TPAs) have taken notice, but employers need to keep mental health parity firmly in mind when they are analyzing benefits for a new plan year.
Holmes Murphy Remains Prepped to Support You!
In short, it looks like a busy year ahead. Holmes Murphy’s compliance team is here to keep you updated and aware throughout the year, so you can continue to control your controllables and even feel confident in those issues you don’t completely control.
Let us know how we can help you feel in control over your health insurance plan compliance. We look forward to working with you in 2023!
Published on: 01.19.23