Health Plan Sponsors Must Prepare for Regulatory Shifts Under New Administration, Advises aequum Leadership Team
CLEVELAND, April 22, 2025 (GLOBE NEWSWIRE) — aequum LLC, a tech-driven, cost containment company serving more than 425 self-insured health plans and their participants in all 50 states, today issued guidance to plan sponsors and administrators on anticipated healthcare policy changes under the new administration. Self-insured employers should prepare now to ensure compliance and cost-containment strategies align with emerging Federal priorities.
“New leadership in Washington means a shift in regulatory focus that directly affects self-insured health plans,” says Christine Cooper, CEO, aequum. “From data access and price transparency to balance billing and PBM reforms, the years ahead are expected to bring policy changes that create both risk and opportunity for health plan sponsors. We also urge plan sponsors to monitor updates from federal agencies and consider plan designs that leverage transparency and consumer engagement, such as reference-based pricing models and health savings account-compatible coverage.”
Upcoming federal rules are expected to target healthcare transparency, consolidation and drug pricing. Key areas to watch:
- Price Transparency Enforcement: Increased audits and penalties for non-compliance with hospital and payer machine-readable file (MRF) requirements.
- Data-Sharing Expansion: New rules likely to extend gag clause prohibitions and require attestation of compliance by carriers and networks—empowering plan sponsors to access critical claims data.
- PBM Reform and Surprise Billing: Regulatory revisions and lawsuits may reshape the No Surprises Act enforcement landscape and arbitration procedures.
“We encourage plan sponsors to review their current administrative relationships and ensure they are positioned to demand full data access, challenge unreasonable charges and adapt to new compliance obligations,” continues Cooper. “With stronger enforcement coming, self-insured plans must partner with firms that can provide the legal, administrative and technical support to protect participants and defend against overbilling. Our experience in handling more than 10,000 claims and recovering millions in disputed charges makes aequum a trusted ally in this evolving environment.”
About aequum LLC
Founded in 2020, aequum LLC serves third-party administrators, medical cost management companies, stop-loss carriers, employer-sponsored health plans, and brokers nationwide to protect plan participants, improve employee satisfaction with their healthcare plans, and generate plan and participant cost savings. aequum LLC helps patients defend against medical balance bills and provides administrative services to its partners. Its sister organization, Koehler Fitzgerald LLC, offers legal advocacy to plan participants. Visit aequumhealth.com.
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