A wide array of healthcare policy changes and compliance issues for employers will continue to evolve in 2022, shaped by the Biden administration, Congress, state legislatures and the courts. Controlling costs, increasing transparency and healthcare access, protecting consumers, and improving competition in the marketplace are key goals driving many of the changes.
Despite partisan gridlock on numerous healthcare issues in Congress, bipartisan support could bring measures to expand telehealth access, broaden access to behavioral health services and further expand transparency, among other things. Democrats may also revive their efforts to extend expanded Affordable Care Act (ACA) subsidies, broaden coverage and control drug prices on a party-line basis under special budget rules. While both parties support paid leave, the partisan divide in approach make enactment of a federal mandate unlikely.
At the state level, the pandemic continues to influence legislative priorities. Employers can expect new or enhanced paid leave benefits, continued focus on mental health parity, and efforts to expand access to telehealth. Rather than wait for federal legislation or regulation, states are also acting to curb drug costs and regulate pharmacy benefit managers (PBMs).
Federal agencies are expected to adjust COVID-19 requirements for employers and group health plans as the pandemic wanes. Implementation and enforcement efforts will concentrate on transparency, surprise billing and mental health parity. The agencies are expected to sharpen their focus on privacy and cybersecurity, as well as on federal nondiscrimination laws, including requirements for employer-sponsored wellness programs. The ACA’s employer shared-responsibility mandate and reporting requirements remain in place, but changes may be coming for Form 5500 reporting.
A wide variety of litigation has implications for employer-sponsored health plans. These cases include challenges to COVID-19 testing payments, pharmacy benefit designs, behavioral health coverage terms, surprise billing and association health plan rules, the ACA’s preventive care mandate, and accommodations for employers with religious or moral objections to contraceptive coverage. In addition, ERISA preemption lawsuits are contesting state laws regulating PBMs and local laws mandating certain employer health coverage. Employers continue to face litigation risks related to COBRA notice requirements.
Download the 39-page print-friendly PDF for details on legislation, regulations and litigation that could affect health and leave benefits in 2022.