By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans,Healthcare Providers / Suppliers,UncategorizedSummary 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 »
By D. Finn Pressly and Edward I. Leeds on Posted in Consolidated Appropriations Act (CAA),Health Plans,Healthcare Providers / SuppliersSummary 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 »
By D. Finn Pressly, Edward I. Leeds and Uchenna J. Osagiede on Posted in Health Plans,Healthcare Providers / Suppliers,Preventive ServicesSummary 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 »
By D. Finn Pressly and Edward I. Leeds on Posted in CARES Act,COBRA,COVID-19,Health Plans,Healthcare Providers / SuppliersSummary 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 »
By Edward I. Leeds on Posted in Consolidated Appropriations Act (CAA),Health PlansIn 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 »
By Edward I. Leeds on Posted in CARES Act,COVID-19,Employee Benefits/Executive CompensationThe 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 »
By Edward I. Leeds on Posted in Consolidated Appropriations Act (CAA),Health Plans,Healthcare,Healthcare Providers / SuppliersIn a Memorandum Opinion and Order issued last week, a federal judge in the Eastern District of Texas vacated significant provisions in the regulations under the No Surprises Act. The order addresses the independent dispute resolution (IDR) process that health plans or providers may initiate to resolve differences about how much a health plan should pay for out-of-network [&hellip… Continue Reading »
By Edward I. Leeds on Posted in CARES Act,COVID-19Following up on their earlier guidance the Departments of the Treasury, Labor, and Health and Human Services have issued an additional set of frequently asked questions and answers on the requirement to cover over-the-counter COVID-19 test kits. The new FAQ primarily offers further explanation of a safe harbor approach described in the earlier guidance. This safe harbor generally applies [&hellip… Continue Reading »
By Edward I. Leeds and Paige A. Haughton on Posted in Consolidated Appropriations Act (CAA),Health Plans,Healthcare Providers / SuppliersSummary The Consolidated Appropriations Act, 2021 (CAA) requires group health plans and health insurers to submit information regarding the costs of prescription drug costs and other health care services each year to the federal government. This is the ninth briefing in Ballard Spahr’s series on the CAA and health transparency regulations. It was originally published [&hellip… Continue Reading »
