President Announces Plan to Combat Surprise Medical Billing, HHS Moves for More Drug Pricing Transparency
On May 9, 2019, President Donald Trump delivered a speech criticizing the practice of surprise medical billing. He announced a general plan of attack and hinted at a few specifics for curbing the trend.
The president’s speech aligned with this administration’s American Patients First initiative—a blueprint for lowering consumer health costs. Here are the four main regulatory aspects called out by the president, suggesting that they might be tackled first:
- In emergency situations, patients shouldn’t have to “bear the burden” of out-of-network costs.
- Balanced billing should be prohibited for emergency care.
- For scheduled nonemergency care, patients should receive an “honest” bill up front—including an itemized list of out-of-pocket expenses the patient must cover.
- Patients should not receive a surprise bill from out-of-network providers they did not choose themselves.
President Trump went on to state that any legislation would cover all health insurance, regardless of how it was acquired. This means individual and group coverage would still be afforded these protections.
Additionally, drug companies will now be “… required to disclose to patients the list price for prescription drugs in TV ads,” according to the Department of Health and Human Services (HHS).
More specifically, the rule requires prescriptions covered by Medicare or Medicaid that cost $35 or more per month for a typical course of therapy to be disclosed. Drugs under that threshold are unaffected.
HHS points out that the 10 most commonly advertised drugs range in price from several hundred to several thousands of dollars for a typical month of treatment.
This announcement keeps with this administration’s commitment to lowering consumer health care costs through greater transparency. If employees do not understand all of their options or how expensive certain drugs or procedures are, they can be on the hook for way more than they could ever afford. These new rule aims to increase price transparency and better protect consumers. Please contact your Higginbotham representative if you have any questions about pricing transparency or surprise medical billing.
HHS Releases FAQs Regarding HIPAA Right of Access as It Relates to Health and Wellness Apps
Recently, the Department of Health and Human Services (HHS) released a set of FAQs from the Office of Civil Rights. These FAQs are meant to address the Health Insurance Portability and Accountability Act (HIPAA) right of access as it relates to health and wellness applications designated for use by patients and application programming interfaces (APIs) used by providers’ electronic health record systems.
The new FAQs explain that once protected health information (PHI) is shared with a third-party application, the HIPAA-covered entity will not be liable for subsequent use or disclosure of electronic PHI as long as the app developer is not itself a business associate of a covered entity or other business associate. Common examples of third-party health apps include Fitbit, MyFitnessPal, Garmin Connect, Google Fit and Apple’s Health app.Employer Takeaway
Employees should be aware that if they request their PHI to be transferred to a third-party health and wellness app, the app won’t receive HIPAA protections. Additionally, the entity that transfers the PHI to the third-party app will not be held liable for subsequent use or disclosure of the PHI.
EEO-1 Pay and Work-hour Data from Both 2017 and 2018 is Due by Sept. 30
Employers have until Sept. 30, 2019, to submit pay and work-hour (“Component 2”) data from both 2017 and 2018 as part of their 2018 EEO-1 Reports, the Equal Employment Opportunity Commission (EEOC) announced on May 3, 2019.
The announcement followed a federal court decision that required the EEOC to collect Component 2 data from 2018 and to decide whether it would collect that data from either 2017 or 2019 as well. The EEOC chose to require the 2017 information and indicated that a system for employers to submit the Component 2 data from both 2017 and 2018 will be available starting in mid-July 2019.
Employers subject to EEO-1 reporting should:
- Ensure that they submit 2018 EEO-1 Component 1 data by May 31, 2019; and
- Prepare to submit both 2017 and 2018 EEO-1 Component 2 data by Sept. 30, 2019.
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