Healthcare Regulation Changes in 2020 That Will Impact How You Manage Your Business

Posted by Susan Berndt on March 3rd, 2020
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Susan Berndt
Susan is a creative marketing professional with a demonstrated history of working in the hospital & health care industry. Susan joined Smart Data Solutions in 2016 focusing on marketing strategy, campaign execution and creating an inbound marketing funnel. She has over 10 years of marketing/advertising experience and over 12 years of customer service experience.

Changes to healthcare regulations can result in major impacts for businesses in the industry. There have already been some regulatory changes in 2020, with more on the horizon. Here are a few healthcare regulation changes that could impact how you manage your business.

More States Requiring Electronic Prescriptions for Opioids

Some states have passed legislation taking effect this year requiring electronic prescriptions for controlled substances. The states in which this law will go into effect are Arizona, Iowa, Massachusetts, North Carolina, Oklahoma, Rhode Island, and Tennessee. Minnesota, Pennsylvania, New York, Connecticut, and Maine have already implemented e-prescribing, and 15 other states have plans to require e-prescribing in 2021 or 2022. This motion is a step towards curbing opioid addictions and overdoses that have climbed year by year. Handwritten prescriptions can be forged, misread, or copied to reuse, and the move to electronic could help eliminate false prescriptions being sent to pharmacies.

This change will create more structure over how controlled substances are prescribed, resulting in a decline of fraudulent written prescriptions. Healthcare professionals are optimistic that this could help reduce the growing opioid epidemic. E-prescribing is nothing new, in fact, it’s been many years of electronically filling prescriptions, which helps limit the use of paper and aids in the continual shift towards clearing clinics and hospitals of paper altogether.

Changes to Essential Health Benefits (EHBs)

Benefits related to the Affordable Care Act received some updated regulations last year that allowed states more flexibility in selecting EHB plans beginning in 2020. These changes were made to the selection of essential health benefits as well as out-of-pocket maximums. Going forward, any 2020 health plan that covers EHBs must cover them with zero annual or lifetime dollar maximums.

Changes such as this result in updates to the explanation of benefits sent out. Your business may want to implement new review measures to ensure that EOBs and claims comply with the new requirements before they go out.

Fewer Restrictions on Special Enrollment Periods (SEPs)

For ACA individual plans, the “open enrollment period” system limits people’s ability to buy health coverage. Often enrolling outside of open enrollment requires a qualifying life event such as getting married, divorced, or changes to dependent statuses to be eligible for enrollment. Lessening these limitations makes it easier for people to enroll and is intended to encourage healthy people to stay obtain insurance and stay insured more easily.

If people fail to buy coverage during open enrollment periods, they may lose the opportunity to buy coverage when they actually need it. This system of open enrollment periods generally only occurs once a year which can make obtaining access to health coverage difficult for some.

The draft version of these new parameters was presented in January of 2020, and looks quite similar to what the Affordable Care Act already offers those people who have lost employer-paid coverage. The ACA is proposing a new system that would allow a “special enrollment period” in which people could buy their own major medical coverage plans, without needing an employer-sponsored plan or other reason.

Changes to 2020 Open Enrollment Dates

Open enrollment dates may change every year for one reason or another, depending on regulations, or what dates fall on what days. The Center for Medicare & Medicaid Services (CMS) has officially established its final version of enrollment dates and deadlines for 2020.
These dates are key to note for developing 2020 individual exchange plans and feeding them into ACA exchange systems:

June 19, 2020 – Plan applications are due.
July 24, 2020 – Plan rates are due.
Aug. 1, 2020 – Proposed rate changes show up on the web.
Aug. 21, 2020 – Plan applications finalized.
Nov. 1, 2020: Open enrollment period begins.

If your business needs to implement new forms, software, or processes, note those key enrollment dates for 2020. There are also a lot of predictions for what may or may not change in 2021, including Medicare for All, increasing health data exchange, and employers switching to self-insured plans from fully-insured.

Staying up to Date on Changes

Staying up to date and following regulatory changes closely is critical for ensuring that your business is prepared when the changes go into effect. Some regulations may require major overhauls in technology and security and you will want to be ready when the time comes. If you are looking to get ahead in preparation for upcoming changes, or of automating your workflows contact Smart Data Solutions to discuss how to get started. We are here to help!

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