Healthcare compliance has big changes in store for the rest of 2018 and beyond

November 12, 2018

Nothing is set in stone, but healthcare compliance leaders should start preparing for the following three changes.

For all the speculation about changing healthcare regulations in 2017, awfully little actually happened between then and 2018. But this year has proven to be a different story, and there are still a few months left for the industry to change even more.

Heavy enforcement of Health Insurance Portability and Accountability Act rules continued through last year, prompting compliance officers to spend the year focused on risk assessments. Although former U.S. Department of Health and Human Services Secretary Tom Price floated the idea of easing HIPAA’s Meaningful Use regulations, Price’s proposal never entered the realm of policy.

Uncertainty around the Affordable Care Act also encouraged risk assessments. The Republican tax reform plan that became law last December repealed the mandate that required individuals to have health insurance. Providers, insurers, and healthcare consumers themselves will face wide-ranging consequences as 13 million Americans lose their health insurance through 2027, assuming the nonpartisan Congressional Budget Office’s prediction pans out.

What Is Yet to Come in 2018 and Beyond

What will the next year in healthcare bring? Will we see further tweaks to the Affordable Care Act? Will it be the year that HIPAA’s restrictions, considered onerous by so many physicians, are finally eased? Nothing is set in stone, but healthcare compliance leaders should start preparing for the following changes:

1. The Overdose Prevention and Patient Safety Act

Introduced in mid-2017, the OPPS Act passed with overwhelming support in the House of Representatives and will be further considered by the U.S. Senate at the end of the year. The act promises to improve the quality of care delivered to those dealing with drug addiction while reducing errors in treatment. The bill is widely supported by both parties and has gained even more momentum after the passing of Jessie’s Law.

Specifically, the OPPS Act will align 42 Code of Federal Regulations Part 2, often referred to as “Part 2,” with HIPAA regulations, enabling the disclosure of protected health information for certain patients. When such a law increases the availability of patient records, providers must implement processes to execute the rule without overdisclosing protected health information. Compliance personnel will need to update rule-based electronic health records and train staff on the new rule.

2. The Every Prescription Conveyed Securely Act

Another part of the push to improve treatment for substance abuse patients is the EPCS Act. EPCS aims to take a bite out of the $78.5 billion per year-not to mention the 115 lives per day - that the U.S. loses due to opioid misuse. The act would force states to move from paper prescriptions to electronic ones, which a handful of states have already done.

This bill was introduced in the House of Representatives at the end of July 2017, and that chamber was still considering the bill as of this past summer, so we might begin to see more significant movement on it by the end of 2018. If enacted nationally, the law would affect providers that prescribe medications, as well as the pharmacies that fulfill them. Currently, only 27.6 percent of providers are prepared for EPCS, compared with 94.5 percent of pharmacies. Under the new law, fax would no longer cut it, so providers should proactively adopt new technology, such as HIPAA-compliant email, and show prescribing physicians how to use it securely.

3. Fallout From the Individual Mandate Repeal

By the end of this year, 3 million fewer people will have market insurance, while 1 million fewer will be covered by Medicaid. Compounding these challenges, President Donald Trump cut health insurance subsidies for insurers that help pay out-of-pocket costs for low-income individuals and families. The healthcare system will have to foot the bill for both cuts, and everyone will be affected.

Careful documentation around changes in insurance premiums, coverages, co-pays, and reimbursements is critical for compliance. Leaders on the business side will need to budget for increases in premiums and decreases in reimbursements and subsidies. On the human resources side, employees must be informed of any changes to their employer-sponsored plans. When in doubt, it’s best to overprepare and overcommunicate about changes to plans and cost structures.

Last year was a quiet one for healthcare compliance, but regulations are always changing. Compliance leaders looking to stay ahead of the curve must keep their eyes on coming regulations, adopt modern technologies and processes, and communicate closely with network providers. 2018 has seen much more activity, but for healthcare leaders who wait, the truly bruising times may still lie ahead.

Hoala Greevy is the founder and CEO of Paubox, a leading provider of HIPAA-compliant email services. A serial entrepreneur, Greevy also founded Pau Spam, an email filtering software service.