By Jean C. Hemphill and Philip E. Legendy on Posted in Health Plans,Healthcare Providers / SuppliersSummary On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) published notice that it will postpone for another three months the finalization of a methodology to audit Medicare Advantage (MA) diagnosis coding data. The final rule could impact payors and providers in unexpected ways, and could fundamentally alter the economics of MA. [&hellip… Continue Reading »
By Jean C. Hemphill, Edward I. Leeds and Paige A. Haughton on Posted in Healthcare,HIPAA,HIPAA and Data Security,Wellness ProgramsThe U.S. Department of Health and Human Services (HHS) has released guidance to address how the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule applies to various entities’ requests for information related to an individual’s COVID-19 vaccination status. HHS emphasized that the Privacy Rule applies only to covered entities, including health plans and most [&hellip… Continue Reading »
By Jean C. Hemphill and Edward I. Leeds on Posted in COBRAThe subsidy for COBRA coverage under the American Rescue Plan Act comes to an end on September 30, 2021. There is no indication at this time that the subsidy will be extended. That means that, beginning October 1, plan and COBRA administrators may start collecting premium payments from individuals who qualified for COBRA because of [&hellip… Continue Reading »
By Jean C. Hemphill and Edward I. Leeds on Posted in COBRA,Health Plans,Healthcare Providers / SuppliersThe IRS issued a new notice that provides guidance on a few issues that were not fully addressed in its earlier notice on the Consolidated Omnibus Budget Reconciliation Act (COBRA) premium subsidy requirements set forth in the American Rescue Plan Act (ARPA). ARPA generally requires the cost of coverage under COBRA between April 1, 2021, and September 30, 2021, to [&hellip… Continue Reading »
By Jean C. Hemphill, Edward I. Leeds and Jessica M. DuBois on Posted in Health Plans,Healthcare Providers / Suppliers,NondiscriminationThe U.S. Department of Health and Human Services (HHS) has announced that its Office for Civil Rights (OCR) will begin enforcing Section 1557 of the Affordable Care Act to prohibit discrimination based on sexual orientation and gender identity. Section 1557 prohibits many health care providers and certain health plans from discriminating against individuals on the [&hellip… Continue Reading »
By Jean C. Hemphill, Edward I. Leeds and Eric K. Temmel on Posted in HIPAA,HIPAA and Data SecurityThe new year began with an unusual amount of activity related to the Health Insurance Portability and Accountability Act (HIPAA). Health care providers, health plans, health care clearinghouses, and business associates subject to HIPAA will need to consider three significant developments—one regulatory, one legislative, and one judicial—relating to the Privacy and Security Rules under HIPAA [&hellip… Continue Reading »
By Jean C. Hemphill and Edward I. Leeds on Posted in Healthcare,LegislationThis alert is the latest in a series from our Employee Benefits and Executive Compensation and Health Care Practice Groups about the most recent federal stimulus bill. We provided an overview of how the law addresses new substantive requirements for health plans and health care providers, see the Health Insurance/Provider Provisions section here. We addressed [&hellip… Continue Reading »
By Jean C. Hemphill and Edward I. Leeds on Posted in Essential Benefits,Health Plans,Nondiscrimination,Plan Design RequirementsThe U.S. Department of Labor (DOL) on Tuesday released final regulations modifying the Association Health Plan (AHP) rules to expand their availability for small and large employers and to address their affordability by eliminating certain coverage requirements applicable to qualified health plans under the Affordable Care Act (ACA). The regulations aim to balance the need [&hellip… Continue Reading »
By Jean C. Hemphill, Edward I. Leeds and John Devine on Posted in Health Plans,Healthcare,Healthcare Providers / SuppliersThe momentary lull in congressional activity on health care provides an opportune time for an update on the efforts to repeal and replace the Affordable Care Act (ACA). Following the House of Representatives’ approval of the American Health Care Act on May 4, 2017, the Senate Republican leadership introduced its own version, the Better Care [&hellip… Continue Reading »
By Jean C. Hemphill, Brian M. Pinheiro, Brenda M. Ching and Edward I. Leeds on Posted in Health Plans,Healthcare Providers / Suppliers,LegislationThe House Ways and Means and Energy and Commerce Committees have released, in two parts, budget reconciliation legislation, the first steps of Congress’ proposal to “repeal and replace” the Affordable Care Act. Reconciliation legislation is limited to budget-related provisions and restricts legislators’ ability to address fully all of the repeal and replacement provisions that we [&hellip… Continue Reading »
By Jean C. Hemphill and Edward I. Leeds on Posted in Employer Responsibilities,Exchange Requirements,Reporting,State ExchangesThe Centers for Medicare and Medicaid Services (CMS) and the IRS have each published guidance on matters arising under the Affordable Care Act (ACA). It is too early to tell whether these measures—some of the first guidance published under the ACA by the new administration—are singular acts or signals of guidance to come, as Congress [&hellip… Continue Reading »
