PA-NABIP Pulse June 2024

PA-NABIP Pulse June 2024

The Facts of the Month

Here is something to mention when discussing health trends in the month ahead.

A new survey from the Kaiser Family Foundation shows that 4 out of 10 American TikTok users trust health information on the app. Younger users, particularly those aged 18-29, show higher trust levels, with 53% saying they trust health information at least somewhat, including 17% who trust it a great deal. Among daily TikTok users, who are predominantly younger adults, 58% trust health information on the platform at least somewhat.

Source: KFF Health Misinformation Tracking Poll: Health and Election Issues on TikTok, June 13, 2024

The Big Three

Each month PA-NABIP identifies three top public policy or legal developments that could impact our members and clients. Here are this month’s big three!

  1. Pennsylvania Legislature Further Advances Telemedicine and Individual Market Subsidy Bills

Last month, we reported on two pieces of critical healthcare legislation making their way through the state legislative process. Over the past few weeks, bills concerning both coverage of telemedicine services and subsidies for individual market coverage have continued to advance. Senate Bill 739, sponsored by Elder Vogel Jr. (R-47), requires health insurance issuers offering fully insured coverage in the state, as well as Medicaid and CHIP to reimburse qualified providers for covered services appropriately provided through telemedicine. It also establishes terms for when payment reimbursement isn’t required, such as if the equipment or service isn’t compliant, the service is inconsistent with the standard of care, or if the service is provided out of network. The bill passed the Senate in May, has been approved by the House Insurance Committee, and is now being considered by the House Appropriations Committee. Given that Pennsylvania is one of only a few states that does not have a legal framework for insurance coverage of telemedicine, PA-NABIP supports this type of framework.

Meanwhile, House Insurance Committee Chair, Patty Kim’s measure, House Bill 2234, which is based on a health policy idea in Governor Shapiro’s 2025 budget proposal was approved by the entire House of Representatives and sent to the Senate for consideration. This measure would invest $50 million in the state’s individual health insurance market reinsurance pool, and then use those monies to create a health insurance subsidy program for lower and middle-income Pennsylvanians who buy coverage through Pennie, the Commonwealth’s individual market health insurance exchange beginning in 2025. In addition, since the bill would provide additional funds to the Commonwealth’s reinsurance pool, it should help other Pennsylvanians purchasing individual market insurance coverage by reducing their premium rates. Pennsylvania-NABIP will continue to monitor this legislation, which appears to be on a fast-track, and keep our membership apprised of the outcome.

  1. Make Sure Clients File and Pay Their 2024 PCORI Fees!

Many employer clients need to be getting ready for an important compliance obligation—the filing and payment of the Patient-Centered Outcomes Research Institute (PCORI) fee on July 31, 2024. Applicable employer group health plans must use the Second Quarter 2024 version of Form 720 to submit their payment, and the Internal Revenue Service just made the form available online.

The PCORI fee is a small annual assessment charged to all group health plans to pay for federal outcomes-based medical research. All businesses that operate self-insured and level-funded health plans, including health reimbursement arrangements (HRAs) even if they are paired with a fully insured plan, and health flexible spending accounts (FSAs) that do not qualify as an excepted benefit must pay the PCORI fee. The fee is based on the total number of people covered by the group plan, including all dependents. Groups whose 2023 plan year ended between January 1, 2023, and September 30, 2023, must pay $3.00 per plan participant by July 31, 2024. For employers whose plan year ended between October 1, 2023, and December 31, 2023, the amount due by July 31, 2024, is $3.22 per plan participant. Employers who offer fully insured group coverage to their employees do not need to worry about the PCORI fee, as health insurance carriers are responsible for paying the fee on behalf of all fully insured health plan participants.

  1. Biden Administration Issues Two New Important Health Privacy Protections

The federal HIPAA privacy rules have been protecting the privacy and data security of Americans’ protected health information (PHI) since 2000. However, there are many entities that collect, hold, interact with, and/or sell people’s personal health data that are not subject to the HIPAA privacy rules. A new final rule issued by the Federal Trade Commission (FTC) makes it clear that vendors of personal health records (“PHRs”) and related entities that are not covered by HIPAA must provide notice to affected individuals, the FTC, and the media if they have a data breach.

The new rule clarifies that the FTC requirements and protections apply to “any online service such as a website, mobile application, or internet-connected device that provides mechanisms to track diseases, health conditions, diagnoses or diagnostic testing, treatment, medications, vital signs, symptoms, bodily functions, fitness, fertility, sexual health, sleep, mental health, genetic information, diet, or that provides other health-related services or tools.” Third-party service providers of such entities also must comply.

The federal Department of Health and Human Services (HHS) also recently finalized changes to the HIPAA privacy rules related to reproductive healthcare information. As a result, health insurance agents and brokers, as well as employers who sponsor group health plans will need to update their HIPAA compliance practices.

The new rules prohibit covered entities (such as group health plans) and their business associates (including insurance agents and brokers) from using or disclosing protected health information (PHI) for the purpose of investigating or assigning liability for reproductive healthcare that was legally provided under either state or federal law. The regulation also bans covered entities and business associates from using or disclosing PHI that could be related to reproductive healthcare for health oversight activities, judicial and administrative proceedings, law enforcement purposes, or to coroners and medical examiners, without obtaining a valid attestation that the use or disclosure is not for a prohibited purpose.

As a result, agents and brokers and their group health plan clients need to make changes to their HIPAA privacy compliance practices. Here is a summary of what different types of employer clients and agents and other business associates need to do on or before the rule takes effect on December 23, 2024:

Covered Entities, Including Employers Offering Self-funded and Level-funded Coverage

<![if !supportLists]>· <![endif]>Comply with the new prohibition and attestation requirement by December 23, 2024, and verify that the health insurance issuer or third-party administrator that provides administrative services for their health plan will comply with the attestation requirement on their behalf.

<![if !supportLists]>· <![endif]>Update all business associate agreements (BAAs) to address the new limits on disclosing PHI related to reproductive healthcare and requiring the attestation, and make sure all business associates, such as TPAs and brokers and other plan vendors sign them by December 23, 2024.

<![if !supportLists]>· <![endif]>Revise their workforce HIPAA compliance training and written policies to reflect the rule changes.

<![if !supportLists]>· <![endif]>Update their HIPAA Notice of Privacy Practices to address the new requirements. HHS has indicated that they will publish an updated model notice of privacy practices before December 23, 2024.

Business Associates, Including Health Insurance Agents and Brokers

<![if !supportLists]>· <![endif]>Revise BAA language to address the new limits on disclosing PHI related to reproductive healthcare and requiring the attestation.

<![if !supportLists]>· <![endif]>Ensure all group health plan clients sign an updated BAA with them by December 23, 2024. BAAs should be obtained regardless of what type of coverage an employer offers (self-funded, fully insured, etc.)

<![if !supportLists]>· <![endif]>Update HIPAA compliance training and written policies to reflect the changes to rules by December 23, 2024.

<![if !supportLists]>· <![endif]>Comply with the rule’s attestation requirement, should they be asked to disclose PHI related to reproductive healthcare for legal purposes.

Employers Offering Fully Insured Health Coverage

<![if !supportLists]>· <![endif]>Provide HIPAA training to any employees who deal with the health plan and could have access to PHI.

<![if !supportLists]>· <![endif]>Update HIPAA privacy policies and procedures to reflect the new rules.

Check This Out!

If you want to expand your health policy knowledge beyond this newsletter, here is a resource to check out!

The Kaiser Family Foundation just released a free online mini-course called Health Policy 101. The sections of the class address what the government does related to health care in the United States including sections on private coverage and public programs like Medicare, Medicaid. It also addresses key laws like the ACA and heavily emphasizes financing and coverage.


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