Upcoming Changes in Medicare, Telehealth, and Healthcare Transparency Initiatives

## Health Insurance and Public Health Policy Updates

Medicare and Federal Health Policy

Medicare continues to be an essential aspect of the American healthcare system, and significant changes are on the horizon for 2024. With the expiry of telehealth coverage and the alternative payment model (APM) incentive payments looming, it is critical for Congress to take action. These changes stem from the relaxed regulations during the COVID-19 pandemic, which allowed greater flexibility in accessing telehealth services. Before 2025, legislative efforts must focus on maintaining these telehealth flexibilities to ensure continuity of care.

Another area of federal health policy development is the potential alteration of the Medicare Physician Fee Schedule (MPFS). Legislators are considering a 3.4 percent decrease to the MPFS conversion factor. Possible reforms could include introducing a new inflationary factor or imposing limitations on budget neutrality adjustments. These changes aim to balance the need for sustainable payments to healthcare providers while controlling federal spending.

Legislative and Regulatory Activities

The Lower Costs, More Transparency (LCMT) Act has passed the House, signaling a significant shift towards improving transparency in healthcare pricing. This legislation mandates stricter price transparency requirements for hospitals, insurers, and pharmacy benefit managers. Parallel efforts in the Senate include advancing bipartisan health bills focused on expanding access to mental health care and reducing the costs of prescription drugs.

In the realm of telehealth, the future of telemedicine flexibilities for prescribing controlled medications hangs in the balance. The Drug Enforcement Administration (DEA) and Department of Health and Human Services (HHS) are expected to make a decision on whether these pandemic-era flexibilities will be made permanent. This decision will have far-reaching implications for the management of chronic conditions and mental health services, which have increasingly relied on telehealth solutions.

Meanwhile, the administration is poised to finalize rules that strengthen parity requirements for mental health and substance use disorder benefits. Such regulations aim to ensure that coverage for these conditions is comparable to that for physical medical conditions, reducing barriers to accessing necessary mental health services.

Efforts to address healthcare affordability continue through incremental legislative measures. Lawmakers are working to reconcile the LCMT Act with the Health Care PRICE Transparency Act 2.0. The objective is to enhance price-transparency regulations for hospitals and health plans, thereby making healthcare costs more predictable and manageable for consumers.

On the state level, initiatives such as the implementation of state-based marketplaces for health insurance are gaining traction. States like Illinois are enacting rate review legislation to safeguard consumers against unfair rate hikes and enhance transparency in insurance pricing. These efforts support the broader goal of making health insurance more accessible and affordable for all citizens.

Finally, the continued implementation of the Inflation Reduction Act marks a pivotal moment in healthcare policy. One of the act’s key provisions is the Medicare drug price negotiation, where the Centers for Medicare and Medicaid Services (CMS) is set to publish negotiated maximum fair prices for selected drugs. This initiative is expected to significantly lower the cost of medications for Medicare beneficiaries.