Top Compliance Issues in 2024

Healthcare is one of the hardest things an HR department manages. Working with a trusted benefits administrator can be a big help in staying compliant when it comes to benefits. But there are many areas of compliance that you need to be aware of, especially because many are changing in 2024. While we have focused a lot on changes to electronic reporting under the Affordable Care Act (ACA) recently, there are many additional areas to consider.

There are some changes we know about and some that could be coming in new legislation this year. 

New Transparency Requirements

While you are likely working with a benefits administrator, a common practice among many employers, there are transparency guidelines in 2024 to be aware of. One is the currently delayed requirement to provide advanced explanation of benefits and potentially new legislation. In the meantime, here are other areas to mind.

  • Cost comparison tool: For plan years beginning in 2023, health plans and issuers were required to make an internet-based price comparison tool available for 500 shoppable items, services, and drugs. For plan years beginning in 2024, the internet-based price comparison tool must be expanded to cover all covered items, services, and drugs.
  • MRFs: Non-grandfathered health plans and issuers must publicly post three MRFs regarding in-network provider rates, out-of-network allowed amounts and billed charges, and prescription drug rates and prices. Federal agencies have ended an enforcement delay for posting the prescription drug file. Future guidance will specify a timeline for complying with this requirement.
  • Prescription drug reporting: Health plans and issuers must report information about prescription drugs and health care spending to the federal government annually. This reporting process is referred to as the “prescription drug data collection” (or “RxDC report”). The annual deadline is June 1, which means that the RxDC report is due by June 1, 2024, covering data for 2023. That falls on a Saturday this year, so the deadline may be extended to the next business day, which is June 3, 2024.
  • Gag clause attestations: Health plans and issuers must annually submit an attestation of compliance with the federal prohibition on gag clauses. The gag clause attestation is due by Dec. 31 of each year.

Mental Health Parity

We’ve talked a lot recently about mental health, supporting your employees, and improving the workplace overall. It also is improving the benefits plans offer to employees. The Mental Health Parity and Addiction Equity Act (MHPAEA) generally prevents health plans and issuers that provide mental health and substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage. 

In recent years, the U.S. Department of Labor (DOL) has made MHPAEA compliance a top enforcement priority, especially because these provisions often impose nonnumerical limits on the scope or duration of benefits, such as prior authorization requirements, step therapy, and provider reimbursement rates. 

Considering the DOL’s continuing MHPAEA enforcement efforts in 2024, employers should consider taking the following steps:

  • Reach out to their issuers or benefits administrators to confirm that a comparative analysis has been completed and is updated
  • Monitor any new legislation, including the issuance of a final rule
  • Watch for warning signs of problematic nonquantitative treatment limitations (NQTLs,) such as fail-first protocols or written treatment plan requirements
  • Consider MHPAEA’s parity requirements before making any changes to the plan’s coverage.

Preventive Care Benefits

The ACA requires non-grandfathered health plans and issuers to cover a broad range of preventive care services without charging copayments, coinsurance, or deductibles when in-network providers deliver the services. The scope of this coverage mandate changes somewhat each year. 

Some of the recent updates that might impact the preventive care coverage this year and going forward include:

  • The end of certain coverage requirements related to the COVID-19 pandemic
  • Ongoing litigation regarding a key part of the ACA’s preventive care mandate
  • Signals from the Biden administration that it might expand access to contraceptive coverage.

Your best plan here is to stay in continual contact with your benefits administrator. If you feel you’re not getting the answers you need, there are other options available. PeopleStrategy offers benefits administration, and we can share more information with you.

Telehealth and HDHPs

To be eligible for health savings account (HSA) contributions, individuals cannot be covered under a health plan that provides benefits, except preventive care benefits, before the minimum deductible for an HDHP is satisfied for the year. Generally, telehealth programs that provide free or reduced-cost medical benefits before the HDHP deductible is satisfied are disqualifying coverage for purposes of HSA eligibility.

But effective at the start of 2020, legislation allowed HDHPs to provide benefits before paying deductibles were met. That legislation is set to expire at the end of the year, but bipartisan legislation has been introduced in Congress that would make this exception permanent. It is another piece that your benefits administrator needs to keep on top of for your compliance. 

Other Potential Developments

Other legislative and regulatory developments are possible in 2024 that would impact health plan coverage in the future. For example, these developments might include:

  • New state and federal oversight of pharmacy benefit managers (PBMs) to help control health care spending, such as requirements for applying drug discounts and rebates and prohibitions on spread pricing
  • New state insurance coverage mandates for fully insured health plans, such as cost-sharing caps on insulin and mandated coverage requirements for fertility treatments, gender-affirming care, abortion-related services, and substance use disorder treatment
  • Changes to the HIPAA privacy and security rules, which may require updates to HIPAA policies, notices, and business associate agreements.


There are many areas to keep an eye on. Scheduling time each week to review trusted sources for information as well as regular meetings with your benefits administrator can ensure you’re well educated, informed, and receiving the best benefits for your employees. To help, download our 2024 Employee Benefits Market Outlook which dives into what we’ve covered here and more—and in more detail. It’s a great resource for sharing with leadership so everyone can be aware of the potential benefits changes.