HIPAA Security, AI Strategy, and OTP Telehealth Billing

By CCHP - For the first time in two decades, the Department of Health and Human Services (HHS) has proposed significant updates to the HIPAA Security Rule to better protect electronic protected health information (ePHI) from increasing cyber threats. The Notice of Proposed Rulemaking (Proposed Rule) seeks to modernize security safeguards in response to a significant increase in large-scale healthcare breaches caused by hackers and ransomware between 2018 and 2023. Read Full Article…

HVBA Article Summary

1. Enhanced Cybersecurity Requirements for HIPAA-Regulated Entities: The proposed rule mandates stricter cybersecurity measures for HIPAA-covered entities, including maintaining an up-to-date inventory of technology assets, conducting annual risk analyses, implementing robust patch management policies, and requiring multi-factor authentication. Additionally, encryption of electronic protected health information (ePHI), vulnerability scanning, and penetration testing would be required, impacting sectors such as telehealth that handle vast amounts of sensitive health data.

2. Stronger Compliance Monitoring and Incident Response Protocols: The rule emphasizes enhanced compliance documentation and monitoring, requiring a 72-hour disaster recovery plan, annual compliance audits, and more rigorous incident response protocols. Business associates must notify covered entities of contingency plan activations within 24 hours. The rule also seeks public input on regulating emerging technologies such as AI, quantum computing, and virtual reality under HIPAA.

3. Strategic AI Integration in Healthcare and Public Health: The Department of Health and Human Services (HHS) has released an AI Strategic Plan focusing on responsible AI implementation in healthcare. The plan prioritizes catalyzing AI innovation, ensuring ethical and equitable AI use, democratizing AI resources, and developing an AI-empowered workforce. These initiatives aim to balance AI’s transformative potential with safety and regulatory oversight.

A bill that could let AI prescribe drugs

By Mariah Taylor - A U.S. House committee is considering a bill that would allow AI to prescribe medications to patients. The legislation, sponsored by Rep. David Schweikert, R-Ariz., would amend the Federal Food, Drug and Cosmetic Act to classify AI and machine learning technologies as practitioners eligible to prescribe drugs if authorized by the state and approved by the FDA. Read Full Article…

HVBA Article Summary

1. Lack of Specificity in the Bill: The proposed legislation does not outline key details such as which drugs AI could prescribe, the settings in which AI-driven prescriptions would be used, or whether physician oversight would be required. This ambiguity has raised concerns among healthcare professionals.

2. Legislative Process and Historical Context: The bill was introduced in the House and referred to the House Committee on Energy and Commerce in January 2024. A similar bill introduced in January 2023 did not advance past the committee stage, indicating potential legislative hurdles.

3. Skepticism and Future Potential: Physicians have expressed doubts about the bill, calling it "premature." However, there is acknowledgment that AI-driven prescriptions could be an inevitable development. Rep. David Schweikert emphasized the rapid advancement of technology, stating that regulatory frameworks must evolve to keep pace with this "new medical landscape."

Lawmakers press for quick action on PBM bills

By Michael McAuliff - Lawmakers who came within days of passing new restrictions on pharmacy benefit managers are trying to revive those measures as part of major funding bills Congress is rushing to complete. It was unclear if the specific provisions from December's package would be the same, but lawmakers said it was vital to move PBM legislation after the last Congress advanced numerous bipartisan measures, but failed at the last minute to include them in the year-end government funding bill. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. PBM Reform and the March Funding Bill: Proponents of regulating pharmacy benefit managers (PBMs) see an opportunity to attach PBM reform to the upcoming March government funding bill or Republican-led tax cut extensions. Given that some PBM measures could reduce federal spending, they might fit within either legislative package.

2. Key Provisions of the Abandoned PBM Legislation: Previous PBM reform proposals sought to increase transparency, prohibit spread pricing, and de-link PBM compensation from drug list prices. These reforms would have applied to Medicare, Medicaid, and employer-sponsored health plans, aiming to lower prescription drug costs for consumers.

3. Legislative Strategy and Challenges: While Republicans are pushing to include PBM reform in major spending bills, challenges remain, including reconciliation rules, partisan disagreements, and competing legislative priorities. Lawmakers may also pursue standalone PBM bills if they fail to integrate reforms into broader budget legislation.

Senate HELP budget fight could pinch health plan, retirement plan regulators

By Allison Bell - Senators who want to make workers' preventive health tax breaks more generous or U.S. Labor Department compliance programs more aggressive may have to wrestle with other senators for room in the federal budget. The Senate Budget Committee leaders told the Senate Health, Education, Labor and Pensions Committee that it should find some combination of spending cuts and revenue increases that will reduce the federal budget deficit by at least $1 billion over the 10-year period from 2025 through 2024. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Senate Budget Committee's Deficit Reduction Goal: The Senate Budget Committee included a $1 billion deficit reduction target for the Senate Health, Education, Labor, and Pensions (HELP) Committee in a draft budget resolution. This comes as the federal government is projected to record a $783 billion deficit this year on $3.9 trillion in revenue.

2. Budget Review and Oversight: The committee will review the budget resolution during a two-day meeting starting Wednesday, addressing concerns over federal spending, including the U.S. Labor Department’s $14 billion discretionary budget. The Employee Benefits Security Administration, which oversees employer-sponsored health and retirement plans, operates on a $200 million annual budget.

3. Senate HELP’s Role in Benefits and Tax Policy: The Senate HELP Committee has jurisdiction over certain taxes, fees, and federal health benefits programs. Current legislative efforts under its purview include bills to expand prostate cancer screening benefits and provide mental health support for health care workers.

Benefits Expert Discusses GLP-1 Drugs, Trending Benefits, Trump Administration

By Kathryn Mayer - The employee benefits world is constantly in flux. But when you factor in new blockbuster drugs with a high cost for employers, a new presidential administration, and various trending benefits that support employee concerns, it seems there’s more than ever to watch in the space. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Employer Coverage of GLP-1 Drugs: Employers continue to grapple with decisions on covering GLP-1 drugs due to their high costs. Some organizations, like a public-sector plan in Colorado, have already limited coverage, and others may follow suit as they evaluate the long-term financial impact and effectiveness of these treatments.

2. Growth in Employee Benefits: Employers are expanding benefits in key areas, including menopause support, student loan assistance, and financial wellness initiatives. These benefits aim to address employee well-being through resources like flexible work options, financial literacy programs, and potential changes to 401(k) eligibility.

3. Potential Policy Shifts Under a Trump Administration: If Donald Trump returns to office, key health and retirement benefit policies could change, including potential rollbacks of Biden-era fiduciary rules under ERISA and expanded access to HSAs. These shifts could impact employer-sponsored retirement and health benefit structures.

Health care profits flow to shareholders, not patient care, study finds

By Austin Littrell - A new study from Yale School of Medicine (YSM) found that large U.S. health care corporations spent 95% of their net income — totaling $2.6 trillion — on shareholder payouts over the past two decades, raising questions about industry priorities and their impact on patient care and affordability. As a result, physicians and practice owners face increased overhead costs, reimbursement challenges and an increased financial burden pushed onto patients. Read Full Article… 

HVBA Article Summary

1. Rising Shareholder Payouts Over Investments: The study found that healthcare companies in the S&P 500 significantly increased their spending on stock buybacks and dividends, with shareholder payouts surging 315% from 2001 to 2022. This trend raises concerns about prioritizing investor returns over reinvesting in research, infrastructure, and workforce wages.

2. Public Funding and Cost Implications: With approximately 70% of U.S. healthcare spending being taxpayer-funded through Medicare, Medicaid, and employer-insurance tax breaks, researchers argue that escalating shareholder returns contribute to rising healthcare costs. Companies maintain profitability by keeping prices high, impacting affordability for patients.

3. Call for Policy Reforms: Given the heavy reliance on public funds, researchers suggest healthcare corporations should face regulations ensuring a portion of profits are reinvested in patient care, research, and employee wages. They emphasize that healthcare is a fundamental right, urging scrutiny over how healthcare dollars are allocated.

Helping patients overcome cost barriers, insurance disputes to access dental care

By Ricardo Mitrani, DDS, MSD - Across the health-care spectrum, cost barriers stand in the way of patients accessing care. According to a KFF analysis¹ of a National Health Interview Survey,² more than one in four adults (some 28% of those surveyed³ ) reported delaying or skipping dental, medical, or mental health-care services or prescription drugs because of costs. As a result, they potentially exposed themselves to leaving serious and underlying conditions untreated. Read Full Article…

HVBA Article Summary

1. Financial Barriers to Dental Care: The cost of dental care poses significant challenges, with 13% of the population facing financial barriers—far higher than medical, mental health, and vision care. Even insured patients often avoid treatment due to high out-of-pocket costs, deductibles, and denied claims, making affordability a major hurdle.

2. Strategies for Reducing Patient Costs: Dental practices can play a crucial role in helping patients manage costs by assisting with insurance navigation, preauthorization, and claim appeals. Providing clear cost estimates and flexible payment options can prevent delays in necessary treatment and encourage better long-term oral health.

3. Advocacy for Insurance and Claims Assistance: Insurance complexities and claim denials frequently deter patients from seeking care. By proactively educating patients about coverage, advocating for claim approvals, and assisting with appeals, dental providers can help bridge the gap between needed treatments and accessible care.

Long-term care is alive and well - with Lori Martin

By David Saltzman - In this episode, we explore the pivotal role of long-term care insurance in securing financial stability and peace of mind amidst rising health care costs and an aging population. Host David A. Saltzman speaks with our guest, Lori Martin, CLTC and Principal at Envision Benefits, who shares her expertise on the subject. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Importance of Long-Term Care Insurance: The episode emphasizes the crucial role of long-term care insurance in ensuring financial stability and peace of mind, especially in the context of rising healthcare costs and an aging population.

2. Individual vs. Group Markets: Lori Martin, CLTC and Principal at Envision Benefits, discusses the distinctions between individual and group markets for long-term care insurance, highlighting differences in coverage options and the benefits of inflation protection.

3. Legislative Efforts and Tax Deductions: The conversation also touches on current legislative initiatives, the potential for tax deductions related to long-term care insurance, and the significance of marketing and education in boosting plan participation.