After months of contentious campaigning, the 2022 midterm elections have finally backfired. With Democrats retaining the Senate and Republicans gaining control of the House, a deadlock is likely as the division between the two parties continues.
Despite better-than-expected Democratic election results, President Biden The bill was passed by the split parliament. The battle over federal funding and congressional investigations would create a militant environment in which no de facto important legislation would make its way to the president’s desk. action is much more likely to be seen in the form of new regulations enacted by
That said, there is no doubt that we will see legislative ramifications in the mental health and telehealth space. Both the House and Senate recently passed mental health bills, but predictably, some elements of those bills will be included in his Consolidated Appropriations Act of 2023, which passed the House on December 20, 2022. It was
Once the new parliament is operational, employers will need to address several items, including:
COVID Emergency Order Expires
The COVID-19 public health emergency administered by the Department of Health and Human Services (HHS) is set to expire on January 11, 2023. During the pandemic, the cost of COVID-19 testing, vaccines and treatments is heavily subsidized by the federal government. Funds are likely to dry up if the public emergency is not extended, and the cost of these services will now be borne by insurers and ultimately employers.
Similarly, the COVID-19 National Emergency is scheduled to end on February 28, 2023. Declared by President Trump and extended by President Biden, the deadlines for HIPAA Special Enrollment, COBRA Enrollment and Payments, and Health Care Flexible Expenditure Account Claims have been relaxed. A longer grace period for making payments and changes to your benefit plans, more flexibility, and a longer grace period. Once the national emergency is over, employers will return to their pre-declaration status.
Non-Discrimination in Health Programs and Activity Rules
Employers are awaiting final guidance on non-discrimination rules in health programs and activities proposed by HHS in early August. This reinstates and expands the previous regulations relating to Section 1557 of the ACA. This rule prohibits discrimination based on race, color, national origin, sex, age, or disability in any covered health program or activity. The rule reinstates the non-discrimination notice requirement and places an additional administrative burden on employers.
Coverage transparency rule
Employers must continuously perform adoption of transparency in coverage rules, This is intended to “require most group health insurers and health insurers in the group and individual markets to disclose information about prices and cost sharing to participants, beneficiaries and subscribers.” is. The Centers for Medicare & Medicaid Services (CMS) has delayed the implementation of the rule until July 1, 2022 for planning years effective July 1, 2022. Most, but not all, employers have his 1/1 planning year, which must be complied with by January 1, 2023. Most employers rely on their insurance company, carrier her partner, or pharmacy benefits manager to help them comply with these requirements, but the ultimate responsibility lies with the employer.
Changing and inconsistent access to healthcare
with the overthrow of Law vs Wade, Employers will be challenged by newly enacted restrictions on abortion, together with reproductive health and transgender inclusive care. These hot-button issues have received considerable coverage in the national media, but are likely to be resolved in state legislatures and the court system. This is especially difficult for multinational employers. ERISA allows certain exemptions for employers to provide a consistent benefits package across the country, but employers must ensure that regulations at the state or, in some cases, local level ensure that employees have equal access to health care services. I’m starting to realize that it means I don’t have access to the .
At least 13 states now ban most abortions, and employees in those states must find alternative ways to access such care. The same applies to transgender care. With states like Florida criminalizing treating anyone under the age of 18 for transgender care, employers are investigating ways to provide fairness to their employee base. Employers are looking at ways to cover medical procedures and provide travel assistance without violating state law.
Medicare Advantage Payment Reform
The newly seated Congress is likely to get serious about reforming federal Medicare Advantage payments, seeking to remove the financial excesses that have built up in the system over time. and federal agencies for some time, but recently Federal Court Decision and then new york times article We put Medicare Advantage payment reform at the center of the Department of Justice and brought it into the wider public consciousness.
Employers can expect federal action aimed at recovering overpayments from certain plans and directly addressing more widely accepted plan practices in the future. In addition to addressing potential health care system fraud, this initiative is particularly important given the current federal debt situation and the expected continued budget deficit, and will reduce federal spending. could be one of many initiatives undertaken to
Federal Subsidy for ACA Public Marketplace
New Republican House also eyeing Affordable Care Act (ACA) grants extended under the Inflation Reduction Act (IRA) through 2025 as part of the 2021 American Relief Plan Act (ARPA) . It will support nearly 90% of those enrolled in the health insurance market in 2022.
As the House seeks to reduce federal spending, federal debt, and inflation, it may include these subsidies in its potential across-the-board cuts to the federal budget. Employers should use the , you need to track future developments and check your health insurance coverage. ACA subsidy changes could mean that an employer can see more employee movement between her ACA Marketplace and employer group coverage.
Related: Abortion, medical costs impacted midterm voters, study finds
We expect little new legislation from Congress in the next two years, but that doesn’t mean employers can turn a blind eye to what’s happening in Washington. Protracted proposals, regulatory actions and 11-hour trading will bring about major changes. Careful monitoring and readiness to act will prove necessary to move forward.
Sara Taylor, Health Solutions Strategy Leader, Global Solutions & Services, Alight Solutions
