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Navigating the Nuances of Healthcare Compliance and Reporting in 2024 

Tuesday, April 30, 2024
Navigating the Nuances of Healthcare Compliance and Reporting in 2024

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As we delve deeper into 2024, businesses across the United States are faced with an evolving landscape of healthcare compliance and reporting requirements. With regulatory shifts and legislative updates, understanding these changes is crucial for organizations to maintain compliance and optimize their healthcare plans. Here’s an overview of the key themes that have been at the forefront of the healthcare compliance dialogue this year. 

ERISA Fiduciary Duties: Setting the Standard for Plan Management 

The Employee Retirement Income Security Act (ERISA) has long governed the way plan fiduciaries manage employer-sponsored health and retirement plans. This year, the duties under ERISA have been underscored, emphasizing the responsibility to act in the best interests of plan participants. This encompasses setting and adhering to plan terms, ensuring accurate and timely disclosures, and the prudent selection and monitoring of service providers. For self-funded plans, there’s a heightened responsibility, highlighting the need for diligent oversight and governance. 

ACA Reporting: Staying Ahead of IRS Enforcement 

The Affordable Care Act (ACA) continues to shape employer reporting duties. Notably, the IRS has been active in enforcing compliance with Form 1094/1095 reporting. Applicable Large Employers (ALEs) are reminded to diligently report offers of coverage and ensure accuracy in their submissions to avoid potential penalties. 

Premium Tax Credit Eligibility and Legislative Updates 

The intricacies of Premium Tax Credit eligibility have been a focal point, especially given the temporary relief measures expiring in 2025. Employers need to understand the impact this has on their plans and prepare for the implications on both plan design and employee contributions. 

Transparency in Coverage: The Roadmap to 2024 and Beyond 

Transparency requirements have gained significant momentum, particularly with the No Surprises Act and the Price Transparency Tools becoming more embedded into healthcare policy. These requirements aim to provide consumers with a clearer understanding of healthcare costs, pushing for a more open healthcare market. 

Mental Health Parity: Ensuring Equitable Plan Coverage 

Mental health parity has been another significant subject, with the requirement that health plans cannot impose less favorable benefits for mental health treatments compared to physical health. Employers are required to assess both the financial requirements and treatment limitations for parity compliance, safeguarding the rights of their employees to accessible mental healthcare. 

Legally Protected Leave: The Interplay of Federal and State Laws 

The legal framework around leave continues to be an area where federal and state laws intersect, with FMLA providing a federal baseline and state laws offering additional protections. Employers are navigating these waters to ensure they meet the varied requirements and provide the necessary benefits to their workforce. 

Employer Leave Policies: Balancing Compliance and Culture 

Employer leave policies must not only adhere to legal requirements but also reflect the culture and values of the organization. Establishing clear, fair policies that support the workforce without compromising the company’s operational efficiency is a balancing act that requires careful consideration. 

Special Considerations: Gender Identity and Specialty Drugs Coverage 

Coverage considerations are evolving, particularly around gender identity and specialty drugs. With an increased societal and legal focus on non-discrimination, employers are advised to design benefits that are inclusive and considerate of diverse needs. 

As organizations continue to adapt to these regulatory demands and societal shifts, the role of comprehensive benefits planning and compliance strategies becomes ever more important. Employers are encouraged to seek expert guidance and utilize resources to stay informed and compliant in this dynamic environment. 

By ensuring that employee benefits comply with current laws and reflect the needs of the workforce, businesses can foster a supportive, equitable workplace that not only attracts but also retains top talent. As we progress through 2024, staying abreast of these changes is not just a legal necessity, but a competitive advantage. 

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.