Legislative changes have ushered in a new age of patient-centric care, data transparency, and interoperability, with the healthcare industry observing a flurry of legislative activity in recent years. These changes will improve patient care, increase transparency, and modernize health information technology. So, what are some of these changes?
21st Century Cures Act Final Rule (2020): Advances interoperability and supports accessing, exchanging, and using electronic health information.
No Surprises Act (2022): Protects patients from surprise medical bills for emergency services and certain non-emergency services from out-of-network providers.
CMS Interoperability and Patient Access Final Rule (2021): Requires healthcare plans to implement and maintain a secure, standards-based patient access API.
HIPAA Safe Harbor Law (2021): Encourages healthcare organizations to implement recognized security practices to safeguard sensitive health data.
COVID-19 Public Health Emergency (PHE) Policies: Various temporary policies were implemented during the pandemic, with some being phased out or modified as the PHE ended in 2023.
Inflation Reduction Act of 2022: Directs Medicare to negotiate prescription drug prices and expand the Affordable Care Act Program in 2025.
The Mental Health Parity and Addiction Equity Act (MHPAEA) (2022): Prohibits health insurance companies from imposing greater restrictions on mental health and substance use disorder benefits than merely on medical and surgical benefits. This includes financial requirements like copays and treatment limitations (visit limits or prior authorization requirements).
Lower Costs, More Transparency (LCMT) ACT (2023): Ensures healthcare providers and insurers disclose cost information to patients. The bill has a wide- impact across different parts of the healthcare system, including pharmacies, drug manufacturers, hospitals, Medicaid, and Medicare.
UnitedHealthcare: The health insurance provider implemented systems to comply with the No Surprises Act by ensuring patients received clear, concise explanations of out-of-network care costs.
Kaiser Permanente: This leading healthcare provider expanded its telehealth services, integrating telehealth platforms into its care delivery model to offer virtual consultations for primary, specialty, and mental health services.
Cleveland Clinic: The Ohio-based medical center published standard tariffs for online medical services and innovated a tool for personalized cost estimates. The initiative enhanced patients’ awareness of healthcare costs and aligned with the Center for Medicare and Medicaid Services’ hospital price transparency rule.
