Aug 09, 2024
Compliance News Week Ending August 9, 2024
In this Article:
- Hospital Price Transparency
- Current Administration Provides Reporting Tool for Emergency Medical Treatment Violations
- Marketplace Insurers Proposing a 7% Average Premium Hike for 2025
Hospital Price Transparency
In accordance with transparency legislation, beginning in January 2021, hospitals are required to make public their standard charges in two ways: (1) as a comprehensive machine-readable file (MRF); and (2) in a consumer-friendly format. CMS final rules updated the requirements and require hospitals to make changes in how this information is provided beginning July 1, 2024. Hopefully the changes will result in improved access and usability for the pricing information. More detail can be found in CMS’ FAQ.
Current Administration Provides Reporting Tool for Emergency Medical Treatment Violations
Last month, the Biden Administration launched an online tool allowing patients to report violations of a federal law that requires emergency room doctors to provide emergency medical care to patients. The Emergency Medical Treatment and Active Labor Act (EMTALA) dictates to Medicare-participating hospitals that “all patients receive an appropriate medical screening examination, stabilizing treatment, and transfer, if necessary,” regardless of ability to pay.
After the Supreme Court repealed Roe v. Wade, the Biden Administration argued that under the EMTALA, emergency room doctors must provide abortions to pregnant women if it is determined that that abortion constitutes a “stabilizing treatment” under the EMTALA.
In January, the Fifth Circuit of the United States Court of Appeals determined that the EMTALA cannot be used to require emergency room doctors to perform abortions.
The Biden Administration has appealed the Fifth Circuit’s ruling to the Supreme Court. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) announced that an online tool has been launched that will allow individuals to “more easily file an EMTALA complaint,” and included a link to the tool on CMS’ website.
Marketplace Insurers Proposing a 7% Average Premium Hike for 2025
ACA Marketplace insurers are proposing a median premium increase of 7% for 2025, similar to the 6% premium increase filed for 2024, according to a new Kaiser Family Foundation (KFF) analysis of the preliminary rate filings. Insurers’ proposed rate changes – most of which fall between 2% and 10% – may change during the review process.
Although the vast majority of Marketplace enrollees receive subsidies and are not expected to face these added costs, premium increases generally result in higher federal spending on subsidies. The justifications insurers provide for these premium changes also shed light on what is driving health spending more broadly.
Insurers cite growing health care prices – particularly for hospital care – as a key driver of premium growth in 2025, as well as growing use of weight loss and other specialty drugs, according to KFF’s examination of publicly-available documents.
This year, increases in the prices insurers are paying for medical care tend to affect premiums more than growth in the utilization of care. Insurers say workforce shortages and hospital market consolidation, which can put upward pressure on health care costs and prices, are increasing 2025 health insurance premiums.
Meanwhile, growing demand for Ozempic, Wegovy, and other costly GLP-1 drugs, which are used to treat diabetes and obesity, is increasing prescription drug spending.
The full analysis and other data on health costs are available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.
Read the KFF Analysis.
While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it. This publication is distributed on the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice or services. Readers should always seek professional advice before entering into any commitments.
