The ConnXion Volume 02, Issue 1
The new year may have just started, but key regulations are already kicking into gear, with updates and deadlines having started as recently as January 1st, 2024. At WLT, we make it our priority to help you stay in compliance with regulations through our products and services—and that includes keeping you updated and aware of the key regulations that will affect you in 2024.
Transparency in Coverage Final Rule
Compliance regulations stemming from the Transparency in Coverage rule are nothing new, with most phases of the policy having already gone into effect. The final phase, however, began on January 1st, 2024, signaling yet another compliance milestone.
Focused on making sure health plans disclose cost-sharing data to consumers, the first few updates of the TiC Rule required health plans to publicly post machine-readable files listing the pricing data for covered items and services provided by in-network providers, as well as requiring payers to provide an online price comparison tool. This latest—and final—update requires payers to provide cost-sharing estimates for all covered items and services from different providers on the online tool.1
This final update has already gone into effect, so make sure you’re keeping on top of compliance!
A number of other policy updates come from the 2024 Medicare Advantage and Part D Final Rule, which addresses Medicare Advantage marketing, prior authorization, network adequacy, and more. These updates also went into effect on January 1st, 2024, starting with marketing provisions made in the final rule to address misleading marketing in the Medicare Advantage program. These finalized provisions ensure Medicare beneficiaries have the proper knowledge to access and review accurate information on Medicare coverage, as well as prohibiting Medicare logos that are misleading or misrepresentative of the plan.2
Other policies encompassed in the final rule include new network adequacy requirements, requiring Medicare Advantage plans to alert beneficiaries when payers drop their providers from their networks, and streamlining prior authorization requirements, which requires plans to provide a 90-day period where prior authorization is not required for current treatment during the time a beneficiary switches to a new plan.
Medicare Drug Price Negotiation Program
Additionally, in 2023 the Inflation Reduction Act saw the first ten drugs eligible for Medicare price negotiation released, with all ten drug manufacturers agreeing to participate in the process. The new negotiated drug prices will be released on September 1st, 2024, and the prices will take effect on January 1st, 2026.3
As the health space and regulations continue to change, WLT is here to make sure you stay updated and in compliance. Our MediConnX benefits administration portal provides on-demand access to the data and services you need to stay on top of regulations. And with our advanced member engagement portal, MediConnX360, we help employer groups keep safely in compliance with NSA regulations while providing employees with the tools they need for comprehensive transparency.
No matter what new regulations come down the pipeline, our clients and members are always prepared for them.
Get connected today—learn how our system can help you save time, reduce costs, and increase your operation’s compliance: https://wltsoftware.com/systems/