A new year is upon us, and with it, the end of many temporary, COVID-related regulatory and legislative provisions.
Mercer’s U.S. Health Law and Policy team has selected the top healthcare compliance priorities for 2023. Below are highlights of 10 areas considered most likely to impact employee benefits plans. For more context and discussion, see the Mercer site and consult your qualified benefits counsel.
Prescription Drugs
In light of recent presidential directives, Congress and federal agencies will continue working to curb drug and insulin prices and increase access. Be prepared to comply with the new prescription drug reporting requirement under the No Surprises Act (NSA), part of the 2021 CAA.
Group Health Plan Transparency
The final transparency-in-coverage (TiC) rule requires a self-service cost comparison tool for group health plans and insurers for plan years starting after Jan. 1, 2023. Watch for more guidance on the remaining requirements — such as advanced explanations of benefits (EOBs).
Mental Health Parity
Continue complying with the MHPAEA and consider parity requirements when improving a group health plan’s medical or surgical benefit. In 2023, watch for new legislation, guidance and the agencies’ report to Congress, as well as ongoing and emerging parity and behavioral health coverage litigation.
COVID-19 Emergency Wind Down
Review benefit terms or offerings made under temporary COVID-19 relief laws and guidance. When agency relief during the COVID-19 National Emergency expires, confirm proper winding down of extended deadlines for claims and appeals, special enrollment under HIPAA, and continuation coverage elections and payments under COBRA.
Surprise Billing
Confirm administrative compliance with the ban on surprise billing. Make sure plan documents contain the necessary cost-sharing information for all services protected by the NSA. Confirm the latest required surprise billing notice is posted on a public website and included with EOBs.
Preventive Services
Confirm that non-grandfathered group plans cover all ACA-required in-network preventive services without any deductible, copay or other cost sharing. Update plan documents, summary plan descriptions (SPDs), summaries of benefits and coverage (SBCs), and other materials as needed.
Other Ongoing ACA Concerns
Review 2023 group health plan coverage and eligibility terms in light of employer shared responsibility (ESR) strategy, ESR and minimum essential coverage (MEC) reporting duties, and ACA benefit mandates. Ensure that any rehired retirees are not covered under a “retiree only” plan exempt from many ERISA and ACA requirements. Monitor ongoing litigation challenging various ACA provisions.
Family Planning and Gender Issues
Assess the health plan impact of the Dobbs v. Jackson Women’s Health Organization decision. If considering enhanced fertility, adoption and surrogacy benefit programs to support DEI goals and the needs of a diverse workforce, employers should be mindful of compliance issues, including federal tax laws, the ACA and state laws.
State-Level Mandates and Trends
Review state laws impacting group health and benefit plans. Look for additional mandates for fully insured plans. State initiatives may include legislative action and agency rulemaking on paid family and medical leave (PFML) and sick leave, restrictions on PBMs, and changes to telehealth laws. Prepare for 2023 reporting obligations.
HSA, HRA, and FSA Developments
Temporary changes to filing requirements and eligibility may be discontinued, extended or made permanent. Monitor IRS regulations on ICHRAs and direct primary care arrangements as these may impact benefit strategies and compliance. Monitor what the IRS classifies as a tax dependent for account-based plan purposes.
IMPORTANT NOTE: The above is for informational purposes only and should not be construed as legal advice. Consult your broker, third-party administrator (TPA), or qualified benefits counsel for more information.
DataPath, Inc. creates innovative solutions for tax-advantaged benefits administration, including FSAs, HRAs, HSAs, COBRA and more. Please enter your email (above right) to receive notification of new blog articles as they are published.