Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Edward I. Leeds

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Final Rules Overturn Trump Era Health Benefit Rules

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

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

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

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

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

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
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

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
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

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

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 …

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

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

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

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 »

FAQs Provide Guidance on Preventive Care

Posted in Health Plans, Healthcare Providers / Suppliers, Preventive Services
Summary The Departments of Labor, the Treasury, and Health and Human Services have jointly issued FAQs that address the requirement to cover the full cost of certain preventive care services in view of the recent ruling in Braidwood v. Bacerra that invalidated some of those requirements. The Upshot The Bottom Line Given that the Biden Administration expects to challenge [&hellip… Continue Reading »

Court Invalidates Certain Preventive Care Requirements

Posted in Health Plans, Healthcare Providers / Suppliers, Litigation, Preventive Services
Summary Health plans and insurance policies may no longer be required to cover the full cost of preventive care that carries an A or B rating by the U.S. Preventive Services Task Force (USPSTF), following a recent ruling by a federal district court in Texas. The Upshot The Bottom Line Health plans and insurers may [&hellip… Continue Reading »

Unmuzzled: Time to Attest That No Gags Apply

Posted in Consolidated Appropriations Act (CAA), Employee Benefits/Executive Compensation, Health Care Reform, Health Plans, Healthcare, Healthcare Providers / Suppliers, Insured Plans, Short Term Limited Duration Insurance (STLDI)
Summary The Departments of Labor, Health and Human Services, and the Treasury have issued guidance on how health plans and insurers may attest to their compliance with the anti-gag rules of the Consolidated Appropriations Act, 2021 (CAA). The Upshot The Bottom Line By December 31, 2023, health plans and insurers must submit an attestation of [&hellip… Continue Reading »

Strike Two: Court Again Invalidates No Surprises Procedure

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers, Litigation
Summary The U.S. District Court in the Eastern District of Texas vacated certain provisions of the No Surprises regulations that it found inappropriately placed a “thumb on the scale,” and limited the discretion of arbitrators. The Upshot The Bottom Line The court decision provides another victory to out-of-network providers under the No Surprises rules, but it may [&hellip… Continue Reading »

Spring Cleaning: Preparing for the COVID Emergency’s End

Posted in CARES Act, COBRA, COVID-19, Health Plans, Healthcare Providers / Suppliers
Summary The almost three-year-old COVID-19 national emergency and public health emergency declarations (Declarations) are slated to expire May 11, 2023. The Upshot The Bottom Line Plan sponsors should use the coming months to work with their advisors and administrators to ensure that their plan design, documents, and communications are appropriately reviewed and, if necessary, revised [&hellip… Continue Reading »

Reviewing the Welfare Plan Rules Under the Consolidated Appropriations Act, 2021

Posted in Consolidated Appropriations Act (CAA), Employee Notices, Employer Responsibilities, Health Benefits, Health Plans, Non-discrimination Rules
Summary The Consolidated Appropriations Act, 2021, (CAA) and transparency regulations introduced major changes to health benefit plans. These changes continue to evolve with some requirements just now taking effect. The Upshot The Bottom Line The CAA introduced requirements that affect how much plans must pay in certain surprise situations, how plans must document compliance with [&hellip… Continue Reading »

IRS Finalizes Affordable Care Act Reporting Relief

Posted in Employee Benefits/Executive Compensation, Health Plans, Healthcare, Healthcare Providers / Suppliers
Since the inception of the annual reporting requirements under the Affordable Care Act for Forms 1094 and 1095, the IRS has been annually extending the deadline for employers to distribute those reports to individuals. In line with prior guidance, the IRS has now issued final regulations that provide for a permanent, automatic 30-day reporting deadline [&hellip… Continue Reading »

Holiday Relief for Reporting Requirements

Posted in Consolidated Appropriations Act (CAA), Health Plans
In a new set of Frequently Asked Questions, the U.S. Departments of Labor, Health and Human Services, and the Treasury provide significant relief to health plan sponsors and insurers seeking to report on expenditures for prescription drugs and other health care items and services in compliance with the Consolidated Appropriations Act, 2021. The new guidance has [&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 »

Back and Forth to the Future: HHS Issues Proposed Rules on Nondiscrimination

Posted in Employee Benefits/Executive Compensation, Employer Responsibilities, Health Care Reform, Health Plans, Healthcare, Healthcare Providers / Suppliers, Labor and Employment, Non-discrimination Rules, Nondiscrimination
Summary The Department of Health and Human Services (HHS) has issued proposed regulations under the nondiscrimination provisions of Section 1557 of the Affordable Care Act (ACA). The proposed rules restore and augment a number of the nondiscrimination requirements in regulations that were published in 2016, but later stripped away in rules published in 2020. The [&hellip… Continue Reading »

Congress Breathes New Life Into Pre-deductible Access to Telehealth Services

Posted in CARES Act, COVID-19, Employee Benefits/Executive Compensation
The recently enacted Consolidated Appropriations Act, 2022 (CAA 2022) is best known for preventing a government shutdown and providing aid to Ukraine, but its more than 2,600 pages also contain language that revives a telehealth services provision that many health plan sponsors will welcome. The provision allows participants to receive benefits under a High Deductible Health Plan [&hellip… Continue Reading »
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