Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Edward I. Leeds

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Government Issues New Model HIPAA Notice

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA
With the deadline for revising the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Notice of Privacy Practices set for yesterday, February 16, 2026—which was extended to today because of the federal holiday—the federal government published a revised version of its model notice on Friday, February 13, 2026. The model notice comes in three different forms: one for [&hellip… Continue Reading »

PBM Transparency: Next Steps for Plan Sponsors

By D. Finn Pressly and Edward I. Leeds on Posted in Health Benefits, Health Plans, Healthcare Providers / Suppliers, Legislation, Pharmacy Benefits
The federal government recently delivered back-to-back measures forcing pharmacy benefit managers (PBMs) to be more transparent about their business models. However, with this heightened transparency comes a host of new fiduciary obligations for sponsors of health and welfare benefit plans. New Requirements Reforming the PBM industry has been a frequent talking point for the past [&hellip… Continue Reading »

Mark Your Calendar: HIPAA Deadline on February 16

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) regulations require updates to the Notice of Privacy Practices that health plan sponsors furnish to plan participants and health care providers furnish to patients. The updates must be made by February 16, 2026. The Upshot The regulations require changes to the Notice of Privacy Practices for information [&hellip… Continue Reading »

IRS Touches Up the One Big Beautiful Bill

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers
The Internal Revenue Service (IRS) has provided guidance on the changes made to the rules governing health savings accounts (HSAs) in the One Big Beautiful Bill, which was enacted this summer. The Upshot The guidance addresses: The Bottom Line The guidance generally addresses narrow points affecting the HSA changes in the legislation. Comments to the [&hellip… Continue Reading »

IRS Relief Alleviates Some—But Not All—ACA Reporting Issues

By D. Finn Pressly, Christian Fox and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers, Reporting
Employers now may have an opportunity to save money and time by posting a Notice of Availability with respect to the reporting required by the Affordable Care Act (ACA) and Forms 1095-B and 1095-C. The Upshot The Bottom Line Health plan sponsors can save time and money by posting a Notice of Availability with respect [&hellip… Continue Reading »

While Congress Slept: Health Benefit Developments During the Shutdown

By D. Finn Pressly and Edward I. Leeds on Posted in Essential Benefits, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Litigation, Medicare, Medicaid, and CHIP, Non-discrimination Rules, Nondiscrimination
Although much of our attention this fall was focused on the government shutdown, health plan sponsors may be interested in several less-publicized developments affecting group health plans. The Upshot The Bottom Line The two lawsuits and the administrative guidance, along with factors affecting the cost of health coverage, bear watching as each of these matters [&hellip… Continue Reading »

Court Upholds Arkansas Pharmacy Benefit Management (PBM) Reporting Requirements

By Edward I. Leeds and D. Finn Pressly on Posted in Health Benefits, Health Plans, Healthcare Providers / Suppliers, Litigation, Preventive Services
A recent federal district court decision has upheld an Arkansas Insurance Department rule that requires health benefit plans to submit certain pharmacy compensation information to the Department. The court ruled that this reporting requirement is not preempted by ERISA, finding that the rule does not apply exclusively to ERISA plans and that the reporting required by the rule [&hellip… Continue Reading »

Courts Split on Enforcement of No Surprises Rules

By Edward I. Leeds and Rachel Loscheider on Posted in Consolidated Appropriations Act (CAA), Employee Benefits/Executive Compensation, Enforcement, Health Care Reform, Health Plans, Healthcare, Healthcare Providers / Suppliers, Litigation
The Fifth Circuit and the Federal District Court of Connecticut have issued conflicting decisions on whether service providers may sue to enforce arbitration awards under the No Surprises Rules in the Consolidated Appropriations Act, 2021. While the Connecticut court found that a service provider may request a court to order an insurance company to pay [&hellip… Continue Reading »

The OBBBA’s Impact on Employee Benefits and Executive Compensation

By Christian Fox, Edward I. Leeds and D. Finn Pressly on Posted in Flexible Spending Accounts (FSAs), Health Benefits, Health Plans, Healthcare Providers / Suppliers, Legislation
H.R.1—the One Big Beautiful Bill Act (OBBBA)—contains several provisions that directly affect employer-provided benefit programs, primarily health and welfare programs. The Upshot The new budget law’s changes to health and welfare benefits include: Beginning with tax years starting after 2026, the OBBBA also changed the method used to determine the amount of compensation paid to [&hellip… Continue Reading »

Two Recent Supreme Court Injunction Rulings Support Affordable Care Act

By D. Finn Pressly and Edward I. Leeds on Posted in Health Benefits, Health Plans, Healthcare Providers / Suppliers, Litigation, Preventive Services
Two recent U.S. Supreme Court rulings support provisions of the Affordable Care Act, one directly and one indirectly. The Upshot The Bottom Line Plans will need to continue to provide 100 percent coverage for preventive health services with an A or B recommendation from the USPSTF. Based on the Court’s ruling, federal district courts will [&hellip… Continue Reading »

Court Vacates HIPAA Reproductive Information Privacy Regulations

By Edward I. Leeds and D. Finn Pressly on Posted in Health Plans, Healthcare Providers / Suppliers, HIPAA
A federal district court has vacated a federal regulation under HIPAA that provided special restrictions on the disclosure of reproductive health information. The Upshot The Bottom Line Employers will need to watch for relevant developments and consider how they affect their HIPAA compliance measures. They will, in any event, need to consider certain amendments to [&hellip… Continue Reading »

Mental Health Brake: 2024 MHPAEA Regulations Put on Hold

By D. Finn Pressly and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers
A recent court filing offers a reprieve to health plan sponsors in their efforts to comply with final regulations issued last year under the Mental Health Parity and Addiction Equity Act (MHPAEA). In a motion to stay proceedings in a lawsuit challenging those regulations, the U.S. Departments of the Treasury, Labor, and Health and Human Services notified the court [&hellip… Continue Reading »

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 »
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