Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Jean C. Hemphill

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CMS Postponement of Medicare Advantage RADV Audit Rule Keeps Stakeholders Guessing

Posted in Health Plans, Healthcare Providers / Suppliers
Summary 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 »

Dispute Resolution Process is Modified Under the CAA’s No Surprise Billing Rules

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary The Departments of Labor, Treasury, and Health & Human Services have finalized regulations regarding the dispute resolution process implemented under the No Surprise Billing Rules in the Consolidated Appropriations Act. The Departments also have issued important FAQ guidance that addresses many other elements of the No Surprise Billing Rules. The Upshot The new final [&hellip… Continue Reading »

DHHS Approves Updates to Preventive Items and Services to be Covered Without Cost-Sharing

Posted in Cost-sharing Limits, Health Plans, Healthcare Providers / Suppliers, Plan Design Requirements, Preventive Services
Revisions to preventive care and screening guidelines will require health plans and health insurance policies to provide 100 percent coverage for additional services for women, adolescents, children, and infants, following an update issued by the Health Resources Services Administration (HRSA) of the U.S. Department of Health and Human Services (DHHS). The HRSA update modifies certain [&hellip… Continue Reading »

HHS Clarifies Applicability of HIPAA Privacy Rule to COVID-19 Vaccination Status Requests

Posted in COVID-19, Healthcare, HIPAA, HIPAA and Data Security, Wellness Programs
The 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 »

Keeping Up With No Surprises

Posted in Consolidated Appropriations Act (CAA), Cost-sharing Limits, Enforcement, Grandfathered Plans, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Insured Plans, Plan Design Requirements, Short Term Limited Duration Insurance (STLDI)
Summary Two sets of rules were issued last month by federal agencies as part of the No Surprises Act. The Upshot The proposed rules come into play when an individual receives out-of-network care in at least one of the following situations: in an emergency, when an out-of-network provider furnishes services in connection with care provided [&hellip… Continue Reading »

Reminder: COBRA Subsidy to End, Notice of Termination Required

Posted in American Rescue Plan Act (ARP), COBRA, COVID-19
The 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 »

Enforcement Delayed Under the New Health Plan Disclosure Requirements

Posted in Consolidated Appropriations Act (CAA), Cost-sharing Limits, Health Benefits, Health Plans, Healthcare, Healthcare Providers / Suppliers
Summary Three federal agencies, the Departments of Labor, Health and Human Services, and Treasury, jointly released new FAQs on August 20, 2021, regarding compliance with new health plan disclosure requirements of the Transparency in Coverage Final Rules (TiCFR), the No Surprises Act, and additional transparency provisions under the Consolidated Appropriations Act (CAA). In the FAQs, [&hellip… Continue Reading »

COBRA Premium Subsidies – A Little More Guidance (and a Reminder)

Posted in COBRA, COVID-19, Health Plans, Healthcare Providers / Suppliers
The 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 »

New Regulations Aim to Prevent Surprises in Medical Billing

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers, Insured Plans, Short Term Limited Duration Insurance (STLDI)
The U.S. Departments of the Treasury, Labor, and Health and Human Services, along with the federal Office of Personnel Management, have jointly issued interim final regulations under the No Surprises Act. The regulations elaborate on the already detailed requirements in the Act, which was signed into law in December as part of the Consolidated Appropriations Act, 2021. [&hellip… Continue Reading »

HHS to Enforce Section 1557 of the Affordable Care Act to Prohibit Discrimination Based on Sexual Orientation and Gender Identity

Posted in Health Plans, Healthcare Providers / Suppliers, Nondiscrimination
The 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 »

A Fast Start: 2021 Begins With Major HIPAA Developments

Posted in HIPAA, HIPAA and Data Security
The 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 »

New Stimulus Law Seeks to Strengthen Mental Health Parity Compliance

Posted in COVID-19, Healthcare, Legislation
This 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 »

HHS Issues HIPAA Guidance on Contacting Survivors of COVID-19 About Plasma Donation

Posted in COVID-19, HIPAA
The Office of Civil Rights of the U.S. Department of Health and Human Services has issued guidance clarifying how HIPAA’s Privacy Rule permits covered entities (in particular, health care providers and health plans) or their business associates to contact former COVID-19 patients about plasma donation to treat or potentially treat patients. The guidance follows the FDA’s approval of blood [&hellip… Continue Reading »

Update: CARES Act Health Care Provider Relief Fund–What Eligible Providers Should Know

Posted in CARES Act, COVID-19
Note: This is an update to our April 13 alert here. CARES Act 2.0, signed into law on April 24, 2020, authorized additional funding of certain programs established in the initial CARES Act, including supplemental funding for health care providers. The new law also provides more than $300 billion in additional funding for the Paycheck Protection [&hellip… Continue Reading »

NJ Grants Health Care Professionals and Facilities Immunity in Treating COVID-19 Patients

Posted in COVID-19
Tuesday evening, April 14, 2020, New Jersey Governor Murphy signed into law Bill No. S2333, which provides health care professionals, facilities, and systems civil immunity for care given to those affected by COVID-19. The new law additionally authorizes the Director of Consumer Affairs to issue orders temporarily suspending professional and occupational licensing registration requirements. The [&hellip… Continue Reading »

CARES Act Health Care Provider Relief Fund–What Eligible Providers Should Know

Posted in CARES Act, COVID-19
The CARES Act signed into law by President Trump on March 27, 2020, provides for $100 billion in funding for financial relief to Medicare health care providers impacted by COVID-19. On April 10, 2020, the Administration announced that $30 billion of this funding will be disbursed immediately to providers through direct deposit—these direct deposits will [&hellip… Continue Reading »

Health Care and the CARES Act

Posted in CARES Act, COVID-19
On March 27, 2020, Congress passed the CARES Act (the Act), an approximately $2 trillion bill drafted in response to the COVID-19 crisis, with the goal of providing much needed relief for the United States economy. A significant portion of the bill relates to the health care workforce, providing for provisions related to the reauthorization [&hellip… Continue Reading »

OCR Guidance Related to Telehealth Remote Communications During the COVID-19 Emergency

Posted in COVID-19, HIPAA, HIPAA and Data Security
On March 20, 2020, the Office for Civil Rights (OCR) issued guidance in furtherance of its Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. OCR issued the guidance as frequently asked questions (FAQs) published by the Department of Health and Human Services (HHS). This guidance further explains how OCR will exercise [&hellip… Continue Reading »

CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response

Posted in COVID-19
CMS Adult Elective Surgery and Procedures Recommendations: Limit All Non-Essential Planned Surgeries and Procedures, Including Dental, Until Further Notice On March 18, 2020, the Centers for Medicare and Medicaid Services (CMS) issued recommendations to limit all non-essential adult surgeries and dental procedures during the 2019 Novel Coronavirus (COVID-19) outbreak. This guidance comes as health care [&hellip… Continue Reading »

HHS Issues Temporary and Limited HIPAA Waiver for Hospitals

Posted in COVID-19, HIPAA
The Office of Civil Rights, U.S. Department of Health and Human Services, issued an update to its February bulletin, which outlined how the HIPAA privacy rules apply in a state of emergency. The March bulletin largely reiterates the February bulletin and also sets forth a limited waiver of sanctions and penalties against covered hospitals that do not comply [&hellip… Continue Reading »

Coronavirus Reverberates Throughout Health Care Industry

Posted in COVID-19
With the spread of COVID-19, barriers to testing, treating, and getting paid for coronavirus-related care and containment efforts are being identified and addressed by federal and state regulators on a daily basis. Most recently, The firm’s Health Care Group is monitoring these developments and advising clients across the industry on regulatory and transactional matters, including health benefits… Continue Reading »

SECURE Act In; Cadillac Tax Out: The Spending Act Makes Serious Changes to Benefits Rules

Posted in Cadillac Tax, Health Insurance Providers, Health Plans, Healthcare Providers / Suppliers, Legislation, Medical Devices, PCORI, Taxes and Fees
President Trump signed into law a nearly $1.4 trillion spending package that avoided a government shutdown and will fund the government through September 30, 2020. The year-end spending package, signed December 20, 2019, contains a number of retirement and health and welfare provisions that will be of interest to employers and other plans sponsors and [&hellip… Continue Reading »

Health Care & Price Transparency: The Latest

Posted in Health Plans, Healthcare, Healthcare Providers / Suppliers, Insured Plans, Providers
Federal executive agencies recently published two rules, one final and one proposed, aimed at publicizing the various costs associated with health care. A final rule, promulgated by the Department of Health and Human Services (HHS) via the Centers for Medicare & Medicaid Services (CMS), requires hospitals to establish, update, and publish online a list of [&hellip… Continue Reading »

Executive Order Aims to Enhance Transparency in Health Care Costs and Quality

Posted in Flexible Spending Accounts (FSAs), Health Benefits, Health Plans, Healthcare, Healthcare Providers / Suppliers, Insured Plans, Plan Design Requirements, Short Term Limited Duration Insurance (STLDI)
On June 24, 2019, President Trump signed Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First. This is the President’s third executive order affecting the health care industry. Executive Order 13813 issued in October 2017, set the regulatory agenda for Association Health Plans, Short-Term Limited-Duration Insurance, and Individual Coverage Health Reimbursement [&hellip… Continue Reading »
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