Regulatory updates to watch in Q3

These are the health care regulations, announcements and changes to keep on your radar for Q3 2024.

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Staying on top of the legislative changes in an industry as complex and highly regulated as health care can be challenging. That’s why UnitedHealthcare is committed to easing that burden and keeping employers as well as brokers and consultants updated on the legislative changes as they arise.

Here are 3 notices to watch for in Q3: 

Gag Clause Confirmation of Compliance

In early September, UnitedHealthcare will send self-funded employers a Confirmation of Compliance, indicating that UnitedHealthcare completed the annual Gag Clause Prohibition Compliance Attestation (GCPCA).

This means that UnitedHealthcare reviewed its contracts and confirms compliance with the Consolidated Appropriations Act (CAA) Gag Clause requirements, which prohibit health plan sponsors and issuers, such as UnitedHealthcare, from having agreements with health care providers, networks or associations of providers, third-party administrators or any other service providers that prevent the disclosure of quality and cost of care information.

This is designed to help ensure members and patients have the data they need to make informed decisions about their care, including the cost of care.

Anticipated timing: Early September 2024

Who it impacts: Self-funded employers 

Medical Loss Ratio

By mid-September, UnitedHealthcare will provide impacted fully insured employers a final announcement of their Medical Loss Ratio (MLR) check amounts.

This applies to fully insured employers (who are in an MLR aggregation set based on their state, employer size and legal entity) that had a lower MLR than the percentage noted in the Affordable Care Act, which requires that insurers spend at least 80% of premium dollars on medical care for small groups and at least 85% for large groups. If those minimum standards aren’t met, the insurer is required to issue a rebate check to the customer.

The goal of the MLR is to ensure carriers, such as UnitedHealthcare, are being good stewards of their members’ health care dollars and not using a disproportionate amount of those premium contributions toward administrative costs, overhead expenses or profits.

Anticipated timing: Final report and checks to be sent out by Sept. 30, 2024

Who it impacts: Fully insured employers

Section 1557 nondiscrimination

The final rule was released May 6 and is effective July 5, 2024. The rule implements Section 1557 of the Affordable Care Act prohibiting discrimination in health programs and activities receiving federal financial assistance. 

Nondiscrimination requirements include availability of language assistance, accessibility for those with vision, hearing and other disabilities, nondiscrimination in access to care and services including telehealth and decision support tools, and clarification that discrimination on the basis of sex includes gender identity and pregnancy or related conditions. 

Several requirements under Section 1557 will have future effective dates including those requiring notices, certain language and accessibility requirements and a Section 1557 Coordinator to oversee policy, training and grievance procedures.

Anticipated timing: Effective July 5, 2024, with other requirements for nondiscrimination notices and Section 1557 coordinator on Nov. 4, 2024, application to decision support tools May 1, 2025, and language assistance and accessibility notices July 7, 2025.

Who it impacts: Applies to health programs and activities by health insurers and issuers acting as third-party administrators if the entity receives federal financial assistance.

3 additional items we’re watching closely

  • Affordable Care Act (ACA) guidance on accessibility and Consolidated Appropriations Act (CAA) guidance on air ambulance reporting
  • Supreme Court decision on certain preventive coverage requirements under no-cost preventive care
  • Privacy and Reproductive Health Care Final Rule modifying HIPAA to address privacy of reproductive rights, limiting disclosure of protected health information and clarifies which disclosure are permitted reinforcing privacy

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