Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Edward I. Leeds

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Section 1557: Deadlines Approach, But Long-Term Prognosis Unclear Under Executive Orders

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers, Nondiscrimination
Section 1557 of the Affordable Care Act mandates nondiscrimination in health care programs managed or funded by the Department of Health and Human Services (HHS), with upcoming deadlines for compliance set for May and July 2025. However, uncertainties remain regarding enforcement and future regulatory guidance, especially concerning provisions related to transgender discrimination and foreign language [&hellip… Continue Reading »

HHS Proposes Significant Updates to HIPAA Security Rule

By Edward I. Leeds, Gregory P. Szewczyk, Eric K. Temmel and Mudasar Khan on Posted in HIPAA, HIPAA and Data Security, Uncategorized
The U.S. Department of Health and Human Services (HHS) has proposed changes to its Health Insurance Portability and Accountability Act (HIPAA) Security Rule designed to enhance the cybersecurity of health care providers, health plans, and related entities. The Upshot The Bottom Line Public comments on the proposed rule are due on or before March 7, [&hellip… Continue Reading »

Surprise, Surprise! No Surprise Billing Regulations Upheld

By Edward I. Leeds and D. Finn Pressly on Posted in Consolidated Appropriations Act (CAA), Employee Benefits/Executive Compensation, Health Care Reform, Health Plans, Healthcare Providers / Suppliers, Labor and Employment
Summary The Fifth Circuit Court of Appeals recently upheld regulations defining the qualifying payment amount (QPA). The QPA is a key factor in determining how much individuals and health plans must pay out-of-network providers in certain situations, where the individual does not have a choice to receive services in-network. The Upshot The Bottom Line The [&hellip… Continue Reading »

IRS Guidance Expands List of Preventive Care Benefits Under HDHPs

By Rachel Loscheider, Edward I. Leeds and D. Finn Pressly on Posted in Employee Benefits/Executive Compensation, Health Care Reform, Health Plans, Healthcare Providers / Suppliers, Labor and Employment, Plan Design Requirements, Preventive Services
Summary The IRS recently issued Notices 2024-71 and 2024-75, which expand the list of “preventive care” benefits permitted to be provided by a high deductible health plan (HDHP) without a deductible and the list of benefits considered “medical care expenses” under group health plans. The Upshot The Bottom Line Employers that offer health benefits, and particularly those that [&hellip… Continue Reading »

Practical Pointers for Compliance With New MHPAEA Regulations

By Edward I. Leeds, D. Finn Pressly and Christian Fox on Posted in Consolidated Appropriations Act (CAA), Employee Benefits/Executive Compensation, Health Care Reform, Health Plans, Healthcare, Healthcare Providers / Suppliers, Labor and Employment, Mental Health
Summary The Departments of the Treasury, Labor, and Health and Human Services have published final regulations under the Mental Health Parity and Addiction Equity Act that prohibit group health plans and health insurers from imposing nonquantitative treatment limitations that place greater restrictions on benefits for mental health and substance use disorders than for medical and [&hellip… Continue Reading »

DOL Updates Cybersecurity Guidance to Confirm It Applies to All Employee Benefit Plans

By Rachel Loscheider and Edward I. Leeds on Posted in Employee Benefits/Executive Compensation, Enforcement, Health Benefits, Health Plans, Healthcare Providers / Suppliers
Summary The U.S. Department of Labor (DOL) updated its 2021 cybersecurity guidance to clarify that it applies to all employee benefit plans. The DOL guidance confirms that plan fiduciaries, including health and welfare plan fiduciaries, have an obligation to evaluate the cybersecurity procedures of plan record-keepers and other service providers. The Bottom Line While the updates to [&hellip… Continue Reading »

Health Plan Compliance Deadlines Draw Near 

By Edward I. Leeds, Christian Fox and D. Finn Pressly on Posted in Employee Benefits/Executive Compensation, Health Care Reform, Healthcare, HIPAA, HIPAA and Data Security, Labor and Employment
Regulations under Section 1557 of the Affordable Care Act and HIPAA will require health plans and health care providers to take action in the coming months to meet new requirements. Health plan sponsors and providers that have not started to prepare for these new requirements should begin to take measures now. Section 1557. Final regulations under the [&hellip… Continue Reading »

Fifth Circuit Affirms Invalidity of No Surprises Regulations

By Edward I. Leeds on Posted in Employee Benefits/Executive Compensation, Health Care Reform, Healthcare, Labor and Employment
Summary The Fifth Circuit Court of Appeals has affirmed the invalidity of regulations governing the independent review process under the No Surprise Billing Rules. The Upshot The Bottom Line As a result of the ruling, health plans may pay more in out-of-network claims. Health plan sponsors should pay attention to the fees that vendors charge [&hellip… Continue Reading »

Courts Invalidate ACA Regulations Following Demise of Chevron Deference

By Christian Fox and Edward I. Leeds on Posted in Employer Responsibilities, Health Plans, Healthcare Providers / Suppliers, Litigation, Non-discrimination Rules, Nondiscrimination, Uncategorized
Summary Following the U.S. Supreme Court’s decision to overturn its Chevron decision three district courts have struck down provisions in nondiscrimination regulations under the Affordable Care Act that prohibit discrimination based on gender identity. in what constitutes unlawful discrimination.  The Upshot The Bottom Line The full impact of the Loper Bright and Corner Post decisions [&hellip… Continue Reading »

2024 HIPAA Developments

By Edward I. Leeds, Rachel Loscheider and Sofia Reed on Posted in Employee Benefits/Executive Compensation, Employer Responsibilities, Enforcement, Health Benefits, Health Plans, Healthcare Providers / Suppliers, HIPAA, HIPAA and Data Security
Over the course of the past few months, the Office of Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC), both of which are divisions of the U.S. Department of Health and Human Services (HHS), have issued a series of new regulations and guidance related to the Health Insurance [&hellip… Continue Reading »

Final Section 1557 Rules: Highlights for Health Plan Sponsors

By D. Finn Pressly and Edward I. Leeds on Posted in Employee Benefits/Executive Compensation, Employer Responsibilities, Health Benefits, Health Plans, Healthcare, Healthcare Providers / Suppliers, Insured Plans, Labor and Employment, Non-discrimination Rules, Nondiscrimination
Summary The U.S. Department of Health and Human Services (HHS) has issued final regulations on the nondiscrimination rules set forth in Section 1557 of the Affordable Care Act. The new rules apply to certain group health plans, as well as many health care providers. The Upshot The Bottom Line Plan sponsors need to evaluate whether the new [&hellip… Continue Reading »

Final Rules Overturn Trump Era Health Benefit Rules

By Edward I. Leeds and D. Finn Pressly on Posted in Health Plans, Healthcare Providers / Suppliers
Summary The Biden administration has issued two sets of final regulations that overturn rules adopted during the Trump administration pertaining to association health plans and short-term, limited-duration insurance (STLDI). The regulations go into effect June 17, 2024. The Upshot The Bottom Line The new rules come as no surprise, but employers considering entering into an association health [&hellip… Continue Reading »

HIPAA Breach Notifications – A Question of Timing

By Edward I. Leeds and D. Finn Pressly on Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA
Summary Providing notice of a vendor’s HIPAA breach is often difficult, but it can be particularly hard when information is delayed. Sometimes an investigation takes months to complete, and the HIPAA deadline for providing notice may have passed before a health plan or health care provider even knows who was affected by the breach and [&hellip… Continue Reading »

HHS Announces Temporary Copay Accumulator Non-Enforcement Policy

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers
Summary The United States Department of Health and Human Services (HHS) has filed court pleadings stating that it does not intend to initiate enforcement actions against plans that maintain copay accumulator programs. The Upshot The Bottom Line The non-enforcement policy provides welcome—albeit temporary—relief for employers weighing their options following the court’s decision. In court papers [&hellip… Continue Reading »

No Surprises, But Much Uncertainty: The Status of CAA Billing Rules

By Edward I. Leeds and D. Finn Pressly on Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers, Litigation
Summary The rules in the Consolidated Appropriations Act that aim to eliminate much of the surprise from billings by out-of-network providers in particular situations are the subject of continued controversy. The Upshot The Bottom Line If upheld, the district court’s decisions will likely result in higher costs for plans and patients, but there remains much [&hellip… Continue Reading »

Prescription for Chaos: Copay Accumulator Programs Called Into Question

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers
Summary Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision. The Upshot The Bottom Line Plan sponsors should consult with their advisers to determine how this recent federal court decision affects their employee prescription drug benefit design. Some employers may not even know that their benefit [&hellip… Continue Reading »

Details Upon Details: Compliance under MHPAEA’s New Proposed Regulations

By Edward I. Leeds, D. Finn Pressly and Uchenna J. Osagiede on Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers, Mental Health
Summary The Departments of Labor, Health and Human Services, and the Treasury have proposed regulations under the Mental Health Parity Act that build on prior guidance to set forth requirements for an extremely detailed analysis of how a health plan’s nonquantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits compare to those [&hellip… Continue Reading »

New Mental Health Parity Guidance Issued

By D. Finn Pressly, Edward I. Leeds and Uchenna J. Osagiede on Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers, Mental Health
Summary On July 25, 2023, the Departments of Labor, Treasury, and Health & Human Services (the Departments) released joint proposed regulations and other guidance under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the MHPAEA). This alert provides a high-level summary of the much-anticipated guidance; a more detailed analysis of [&hellip… Continue Reading »

Gag-Clause Attestations Due by End of Year

By Rachel Loscheider and Edward I. Leeds on Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary By December 31, 2023, health plans and insurers must submit an attestation of compliance with the anti-gag rules of the Consolidated Appropriations Act, 2021 (CAA). The rules apply to all agreements entered into on or after the date that the CAA was enacted (December 27, 2020), and the first attestation applies retroactively to that [&hellip… Continue Reading »

Comprehending the Non-Comprehensive: Proposed Rules Tackle Some Non-Traditional Coverage

By Edward I. Leeds and Uchenna J. Osagiede on Posted in Health Plans, Healthcare Providers / Suppliers, Insured Plans, Short Term Limited Duration Insurance (STLDI)
The Departments of Labor, Health and Human Services, and the Treasury have published a set of proposed rules that impose new limits on two types of benefits: short-term limited-duration insurance (STLDI) and fixed indemnity coverage. STLDI STLDI is a form of temporary health insurance originally intended to fill gaps in coverage. It does not offer comprehensive health [&hellip… Continue Reading »

Meet me at the Corner of No Surprises and …

By D. Finn Pressly and Edward I. Leeds on Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary The Departments of Labor, Health and Human Services, and the Treasury have issued guidance that coordinates application of the No Surprise Billing rules under the Consolidated Appropriations Act, 2021, with the cost-sharing limits under the Affordable Care Act and the requirement to provide access to cost information through an internet-based self-service tool under the [&hellip… Continue Reading »

COVID-19 Coverage Without a Deductible Ends After 2024

By D. Finn Pressly, Edward I. Leeds and Rachel Loscheider on Posted in COVID-19, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Plan Design Requirements, Preventive Services
The Internal Revenue Service (IRS) has issued new guidance, Notice 2023-37, which states that for plan years ending after December 31, 2024, HSA-compatible high-deductible health plans (HDHPs) will no longer be permitted to cover COVID-19 testing and treatment before the minimum deductible is satisfied. This guidance answers the question of how long these exceptions to the [&hellip… Continue Reading »

Preventive Care Rules Remain in Place for Now

By Edward I. Leeds, Rachel Loscheider and D. Finn Pressly on Posted in Health Plans, Healthcare Providers / Suppliers, Plan Design Requirements, Preventive Services
The Fifth Circuit Court of Appeals has stayed the broad application of a district court decision that would have invalidated a number of preventive care requirements under the Affordable Care Act. As a result, health plans, other than those directly involved in the litigation, will continue to be required to cover the full cost of preventive [&hellip… Continue Reading »

Reminder: Reporting Requirement for Health Care Costs One Month Away

By Edward I. Leeds and D. Finn Pressly on Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Health plan sponsors and health insurers will need to report prescription drug and other health plan costs (RxDC reporting) for 2022 by June 1, 2023. Unlike the RxDC reporting requirements for 2020 and 2021, this deadline is not expected to be delayed. Plan sponsors and insurers will benefit from the relaxation of some of the [&hellip… Continue Reading »
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