Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Jean C. Hemphill

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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 Healthcare, HIPAA, 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, Plan Design Requirements
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 COBRA
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, 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
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
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 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 »

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, Plan Design Requirements
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 »

District Court Rules ACA Unconstitutional

Posted in Health Plans, Healthcare Providers / Suppliers, Individual Coverage Mandate, Litigation
The Affordable Care Act returned to the front page this weekend when a federal district court in Texas issued an opinion striking down the entire law as unconstitutional. The case arose from a lawsuit filed by a contingent of Republican state attorneys general, one governor, and a few individuals. They asserted that Congress’s elimination of [&hellip… Continue Reading »

Final Regulations Expand Availability of Individual Insurance Not Meeting ACA Requirements

Posted in Annual and Lifetime Limits, Essential Benefits, Excepted Benefit Plans, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Individual Coverage Mandate, Plan Design Requirements, Preexisting Conditions
The U.S. Departments of the Treasury, Labor, and Health and Human Services have jointly issued final rules modifying the definition of short-term, limited-duration insurance (STLDI). STLDI provides health coverage that is intended to be transitional in nature. It is not regarded as individual health insurance or minimum essential coverage and is exempt from certain Affordable [&hellip… Continue Reading »

DOL Releases Final Regulation Expanding Association Health Plans

Posted in Essential Benefits, Health Plans, Nondiscrimination, Plan Design Requirements
The 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 »

Bipartisan Budget Act of 2018 Enacts Changes to Employee Retirement and Health Benefit Plans, and Medicare

Posted in Accountable Care Organizations, Health Plans, Healthcare Providers / Suppliers, Legislation, Medicare, Medicaid, and CHIP
Following a brief shutdown of the federal government, on February 9, Congress passed and President Donald J. Trump signed into law the Bipartisan Budget Act of 2018 (Budget Act), which provides Congress until March 23 to enact appropriation and certain other funding measures and establishes a general agreement on spending that will last into 2019. [&hellip… Continue Reading »

IRS Prepares to Enforce ACA Employer Mandate

Posted in Employer Mandate/Shared Responsibility (Pay or Play), Employer Responsibilities, Enforcement, Health Benefits, Health Plans, Healthcare, State Exchanges
The IRS has announced its intent to begin enforcing the employer-shared responsibility provisions (otherwise known as the employer mandate or pay-or-play provisions) of the Affordable Care Act for the 2015 calendar year. The IRS also published a template letter that it will mail to any applicable large employer (ALE) if it determines the ALE owes [&hellip… Continue Reading »

Developments in the Affordable Care Act

Posted in Essential Benefits, Exchange Requirements, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Legislation, Litigation, Premium Tax Credit, Premium Tax Credit (Exchange Subsidies), Stand-Alone HRAs, State Exchanges
After a brief lull in activity, recent developments are likely to involve all three branches of government in addressing issues under the Affordable Care Act. The Legislature: It is often said that Congress rarely takes action until a crisis needs to be addressed. With the demise of this summer’s repeal and replace effort, initiatives to [&hellip… Continue Reading »

Recess Update on Repeal and Replacement of the Affordable Care Act

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

ACA Repeal and Replace Plan is Released

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

CMS, IRS Address Affordable Care Act Issues in Transition

Posted in Employer Responsibilities, Exchange Requirements, Reporting, State Exchanges
The 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 »

Data Breach Class Action Reinstated Against Horizon Healthcare Services, Inc.

Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA, Litigation
The U.S. Court of Appeals for the Third Circuit has vacated a district court’s dismissal of a data breach class action filed against Horizon Healthcare Services Inc., in the wake of the 2013 theft of two computer laptops containing unencrypted personal information of Horizon Healthcare plan members. The decision potentially expands the circumstances under which [&hellip… Continue Reading »
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