Regulatory updates to watch in Q4

By Dec. 31, 2024, UnitedHealthcare will attest to the Centers for Medicare & Medicaid Services (CMS) on behalf of fully insured and level funded customers that UnitedHealthcare completed the annual Gag Clause Prohibition Compliance Attestation (GCPCA), confirming compliance with the Gag Clause prohibition.

Self-funded (ASO) customers should submit their own attestation of compliance by Dec. 31, 2024, using the Confirmation of Compliance letter UnitedHealthcare has made available to them on uhc.com, which was also included in the September Connect newsletters.

ASO customers wishing to have UnitedHealthcare attest for coverage on their behalf should reach out to their UnitedHealthcare representative by Nov. 1, 2024. Customers will need to sign a letter of direction confirming their request and provide requested data via an email their account team will send to them. 

The Gag Clause prohibits health plan sponsors and issuers, such as UnitedHealthcare, from having agreements with health care providers, networks or associations of providers, third-party administrators or any other service providers that prevent the disclosure of quality and cost of care information. This is designed to help ensure members and patients have the data they need to make informed decisions about their care, including the cost of care.

The Department of Health and Human Services (HHS) published Section 1557 final rule on May 6, 2024. The final rule implements Section 1557 of the Affordable Care Act (ACA), prohibiting discrimination in health programs and activities receiving federal financial assistance. The final rule was made effective July 5, 2024. However, certain requirements under the law have dates specific to Q4 2024.

As a covered entity, UnitedHealthcare has updated the nondiscrimination notice for use beginning Nov. 4. This will be provided annually and upon request and will be available on uhc.com and in locations where services are provided to the public. The notice of non-discrimination will also be updated in applicable documents.

The notice of language availability including taglines has an effective date of July 7, 2025. Applicable documents will be updated with this notice by the July effective date.

UnitedHealthcare also has designated a Section 1557 Coordinator responsible for overseeing the nondiscrimination policies, training and grievance procedures and will continue to ensure compliance with additional nondiscrimination requirements that apply to health programs and activities provided through telehealth services. Patient decision support tools and additional notice requirements are scheduled for implementation in Q3 2025.

Customers eligible for Medical Loss Ratio (MLR) rebates will receive them by September 30, 2024. This applies to fully insured employers who are in an aggregation set (state, employer size, legal entity) that had a lower MLR than the percentage noted in the Affordable Care Act, which requires that insurers spend at least 80% of premium dollars on medical care for small groups and at least 85% for large groups.

The goal of the MLR is to ensure carriers, such as UnitedHealthcare, are being good stewards of their members’ health care dollars and not using a disproportionate amount of those premium contributions toward administrative costs, overhead expenses or profits.

Beginning Dec. 23, 2024, amendments to the HIPAA (Health Insurance Portability and Accountability Act) Privacy rule will prohibit regulated entities from using or disclosing an individual’s protected health information to conduct a criminal, civil or administrative investigation into or impose criminal, civil, or administrative liability on a person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive health care; and to identify any person for such purpose. 

Also, regulated entities may only use or disclose protected health information potentially related to reproductive health care for purposes of health oversight activities, judicial and administrative proceedings, law enforcement, or to provide information about decedents to coroners and medical examiners, if an attestation is first obtained that satisfies certain requirements, including a confirmation that the requested use or disclosure is not for one of the prohibited purposes.

UnitedHealthcare will request and secure an attestation when required as outlined above. HHS has provided a model attestation. UnitedHealthcare will also update its Notice of Privacy Practices (NPP) prior to the Feb. 16, 2026 compliance date.