US healthcare payers face complex compliance challenges from the 2025 Budget Reconciliation Act, requiring advanced technology for interoperability, eligibility automation, and regulatory adherence. Strategic IT partnerships enable payers to streamline Medicaid/Medicare processes, implement FHIR standards, and leverage AI-driven solutions for cost reduction and patient access.
In 2025, healthcare payers face one of their most complex compliance landscapes yet. The recently enacted Budget Reconciliation Act of 2025—also called the One Big Beautiful Bill Act—introduces sweeping changes across Medicaid, Medicare, and the Affordable Care Act (ACA). These changes will significantly affect coverage eligibility, reporting requirements, and cost management. As payers adapt, technology-driven solutions are proving essential to maintain compliance, efficiency, and patient access. According to Centres for Medicine and Medical Services, U.S. healthcare spending has skyrocketed from $74 billion in 1970 to $4.9 trillion in 2023, highlighting why healthcare payers increasingly rely on technology and automation to reduce costs and stay compliant with healthcare legislation.
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). which can be streamlined through Brillio’s digital solutions for financial services to ensure greater transparency and efficiency in healthcare payment processes.
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.
At Brillio, our healthcare payer technology solutions empower US payers to enhance compliance, interoperability, and automation while navigating complex healthcare legislation.
