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2021 – New Healthcare Regulations: What You Need to Know

April 1, 2021
April 1, 2021

Healthcare regulations change at an extraordinary pace. Last year was, well… it was 2020, an extraordinary year in healthcare that will no doubt be studied by future healthcare leaders in years to come. Healthcare providers and administrators had to remain nimble in order to deal with the changes in the healthcare landscape driven by the emergence of COVID-19. As we head into 2021 with a vaccine for the virus, it is worth a quick look at some of the many  emerging healthcare regulations, a few of which were temporarily put on hold in 2020.

What is New in 2021?

  1. COVID-19 Vaccine Update:
    Patients will not be paying for their COVID-19 vaccines. In the final quarter of 2020, the Center for Medicare and Medicaid Services (CMS) said that Medicare, Medicaid, and all private insurers would be required to cover the cost of vaccines for beneficiaries and members. The new rule also established the rate for both single and double dose vaccines. The Medicare rate for a single dose vaccine will be $28.39. For vaccines requiring two or more doses, the initial dose or doses will be reimbursed $16.94, and final doses will be reimbursed at $28.39. The rule covers all FDA-approved vaccines, including those approved for emergency use.

    CMS is also requiring that the Children’s Health Insurance Program (CHIP) and state Medicaid programs administer the vaccine at no cost to members. Similarly, the Departments of Labor, Treasury, and CMS are requiring most health plans to cover a no-cost vaccine. Uninsured Americans can also receive a no-cost vaccine, and providers can be reimbursed through a Provider Relief Fund.
  2. Telehealth and Reimbursement Updates for Home Health:
    There were reimbursement updates for home health providers. In addition to a 1.9% increase in reimbursement, there was also a smaller rate increase (0.7%) for home infusion therapy services.

    During the pandemic, telehealth has emerged as a viable option for Americans to connect with healthcare providers, and now home health providers may also provide telehealth visits to Medicare beneficiaries who have remote patient monitoring and other telecommunication services included in their plan of care.
  3. Price Transparency for Hospitals and Health Plans: 
    The cost of healthcare services is often nearly invisible to healthcare consumers, but that is about to change. Under this rule, hospitals must list standard prices for 300 “shoppable services,” as well as the lowest prices they will accept from consumers paying out of pocket. CMS has also finalized a rule that requires health plans to share the rates that they negotiate with hospitals and other healthcare providers. The rule requires insurers to provide online tools that will help members understand the negotiated rates for services as well as their likely out-of-pocket costs. When requested by a member, the plans must also share this information in writing.
  4. The Interoperability Rule Is Final:
    While Health and Human Services (HHS) finalized the Interoperability Rule in July of 2020, enforcement of the rule has been delayed until later this year due to the pandemic, giving hospitals some additional time to prepare. The rule is aimed at providing patients with more access to their electronic health information in a standardized way.

    The interoperability rules require payers to: implement and maintain the Patient Access API (Application Programming Interface) by July 2021, ensure that Information Technology departments, staff and policies do not block patient access to their electronic health information, and ensure that API technology is sufficiently compatible with web applications so that patients can get access to their records without additional steps. 


2021 and Regulatory Vigilance
The pandemic brought truly unprecedented changes in healthcare, and significant delays for some regulations’ taking effect, but the approval of vaccines brings hope to weary providers. However, that relief also means that we are edging closer towards implementation deadlines for some new regulations. Organizations working in healthcare should stay vigilant for implementation updates for these and other new requirements.