New Disclosure Requirements for TPAs that Contract with ERISA Group Health Plans

New transparency laws included in the latest Covid-19 relief act in December affect third-party administrators and other providers who work with ERISA group health plans. Included in these new regulations is the requirement for “covered service providers” to disclose their direct or indirect compensation.

Indirect compensation could include anything from transparency tools or vendors, compliance services, and third-party administration services. Read more about what TPAs will need to disclose.


Trump Era Regulations including HIPAA Amendments on Hold

Before the turnover in the administration, President Trump’s Office for Civil Rights (OCR) proposed HIPAA amendments. These amendments stated that the OCR would not penalize organizations using online or web-based applications for Covid-19 vaccination scheduling. The Biden administration has put a hold on these exceptions until they can complete a more thorough review. Read more.


Reimbursement Cuts and the Effect on Covid Long-Haulers

Covid “long-haulers” are those who survived the virus but did not escape longer-term effects. These effects can include the need for physical therapy or rehabilitation in addition to mental health services

Recently, the CMS proposed a 10% cut to these kinds of services. Eventually, CMS settled on a 3% cut. These cuts could exacerbate the shortage of psychologists available in some areas or cut out physical therapies altogether. Read more.

Source: US News & World Report

More than 90 Hospitals Join CMS Hospital at Home Waiver Program

In November, the CMS announced initiatives to relieve stress on hospitals that were starting to see a surge of Covid-19 patients.
One of these initiatives included a program that allowed hospitals to provide some health care services outside the hospital walls, and in patients’ homes.

So far, 92 hospitals have participated and are now waiting to see if the waiver will be made permanent under the Biden administration. Read more.

Source: Healthcare Innovation

Merger Could Indicate Changes for BUCA:

Commentary by Chacko Kurian, President, Complete Health Systems

A merger between Change Healthcare and OptumInsight, combined with the recent regulatory changes and rules on transparency portend changes in the health insurance industry. The competitive advantage of using confidential provider pricing contracts may not be as significant going forward. Read the merger story here.

Source: BusinessWire

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