Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Edward I. Leeds

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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 »

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

Posted in Employee Benefits/Executive Compensation, Health Care Reform, Health Plans, Healthcare, Healthcare Providers / Suppliers, Labor and Employment, 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 »

The Element of Surprise – The No Surprises Rules Become a Little Less Predictable

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

The CAA Prescription Drug Benefit Reporting Requirement

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

The CAA’s New Rules for Health Care Provider Directories

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary The Consolidated Appropriations Act (CAA) requires each group health plan and health insurer with a network of providers to maintain a database on a public website that lists the name, address, specialty, telephone number, and digital contact information for each provider that directly or indirectly participates in the network. These new standards are effective [&hellip… Continue Reading »

Provider’s Claims for COVID-19 Screening Charges Move Forward

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Addressing motions to dismiss, a district court in Texas has found that a provider may proceed with its lawsuit to recover the full amount of its charges for COVID-19 diagnostic testing under the FFCRA and CARES Act from an insurer. The FFCRA and CARES Act require health plans and insurers to pay the amount published by a [&hellip… Continue Reading »

The CAA’s New Identification Card Requirements

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary To help individuals better understand the costs they will bear for medical care, the Consolidated Appropriations Act (CAA) requires health plan ID cards to include clear information about deductibles and out-of-pocket maximum limitations as well as a telephone number and website address where enrollees can obtain additional information about their coverage. This is the [&hellip… Continue Reading »

Understanding the New Continuity of Care Rule

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary Under a new rule introduced by the Consolidated Appropriations Act, 2021 (CAA), a health plan or insurer must offer an enrollee the opportunity to elect a transitional period of continued care with a provider whose participation in the applicable network ends while the enrollee is in a course of treatment for certain medical conditions. [&hellip… Continue Reading »

Report Highlights Expanded Enforcement of Mental Health Parity and Addiction Equity Act

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers, Mental Health
Summary The Departments of the Treasury, Labor, and Health and Human Services jointly issued a report to Congress, fulfilling obligations that they have with regard to the Mental Health Parity and Addiction Equity Act (MHPAEA) and Consolidated Appropriations Act, 2021 (CAA). The report offers valuable insight into the departments’ approach to enforcing the MHPAEA and, [&hellip… Continue Reading »

Prohibition Against Gag Clauses

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary Health plan vendors sometimes impose contractual restrictions on the disclosure of data that they consider to be confidential or proprietary. A number of new rules aim to foster transparency and require disclosure of pricing and other information that might otherwise be subject to those restrictions. The Consolidated Appropriations Act, 2021 (CAA) prohibits a health [&hellip… Continue Reading »

Health Plan Fiduciaries Must Solicit Information From Brokers and Consultants

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary The Consolidated Appropriations Act, 2021 (CAA) requires the disclosure of information to ensure that brokers and certain consultants receive no more than reasonable compensation for their services. This is the fourth briefing in Ballard Spahr’s series on the Consolidated Appropriations Act, 2021 (CAA) and transparency regulations. It was originally was published in November 2021. [&hellip… Continue Reading »

Understanding the New Health Care Transparency Requirements

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary New rules require group health plans and insurers to disclose pricing information in three phases. This is the third briefing in Ballard Spahr’s series on the Consolidated Appropriations Act, 2021 (CAA) and transparency regulations. It was originally published in November 2021. The first installment addressed the new No Surprises Rules. The second focused on Understanding the [&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 »

Understanding the Mental Health Parity and Addiction Equity Act

Posted in Consolidated Appropriations Act (CAA), Employer Responsibilities, Mental Health, Reporting
Summary This is the second briefing in our series on the Consolidated Appropriations Act, 2021 (CAA) and transparency regulations. It concerns a new rule under the Mental Health Parity and Addiction Equity Act (MHPAEA) that requires health plans to conduct and document an analysis that compares the nonquantitative treatment limitations applicable to benefits for mental [&hellip… Continue Reading »

Understanding the Mental Health Parity and Addiction Equity Act

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary This is the second briefing in our series on the Consolidated Appropriations Act, 2021 (CAA) and transparency regulations. It concerns a new rule under the Mental Health Parity and Addiction Equity Act (MHPAEA) that requires health plans to conduct and document an analysis that compares the nonquantitative treatment limitations applicable to benefits for mental [&hellip… Continue Reading »

Understanding the New ‘No Surprises Rules’

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary The following is the first publication in our series on the Consolidated Appropriations Act 2021 (CAA) and transparency regulations. It concerns the rules designed to prevent surprise billings. These No Surprises Rules primarily protect individuals who receive care from an out-of-network provider in situations where the individual has little or no choice about the [&hellip… Continue Reading »

Temporary Enforcement Policy Addresses CAA’s Health Plan Service Provider Disclosure Requirements

Posted in Consolidated Appropriations Act (CAA), Employer Responsibilities, Enforcement, Grandfathered Plans, Health Benefits, Health Plans, Healthcare Providers / Suppliers, Insured Plans, Plan Design Requirements, Reporting, Wellness Programs
Summary The U.S. Department of Labor (DOL) has issued a temporary enforcement policy to address frequently asked questions about the requirement for certain service providers to disclose direct and indirect compensation data to group health plan fiduciaries under the Consolidated Appropriations Act (2021) (CAA). The Upshot The CAA’s disclosure requirement applies to entities providing brokerage or consulting services [&hellip… Continue Reading »

Health Plan Coverage Required for COVID-19 Testing

Posted in Consolidated Appropriations Act (CAA), Health Plans, Healthcare Providers / Suppliers
Summary Health plans now are required to cover the cost of over-the-counter COVID-19 test kits obtained without a health care provider’s prescription or clinical assessment. The new requirement is addressed in a set of FAQs issued January 10 by the U.S. Departments of the Treasury, Labor, and Health and Human Services. The Upshot Plans must meet the [&hellip… Continue Reading »

Upcoming Compliance Deadlines for Health and Welfare Plans

Posted in Consolidated Appropriations Act (CAA), Employer Responsibilities, Flexible Spending Accounts (FSAs), Health Benefits, Health Plans, Healthcare Providers / Suppliers, Mental Health, Plan Design Requirements, Reporting
Summary Throughout 2020 and 2021, employers sponsoring health and welfare plans have needed to respond to a myriad of legislative and regulatory changes arising from the COVID-19 pandemic and new health legislation. To comply with these changes, employers may need to work with their vendors, amend their plans, and take other action. In this alert, [&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 »

COVID-19 Vaccination Incentives: Restrictions that Come with Rewards

Posted in Employer Mandate/Shared Responsibility (Pay or Play), Employer Responsibilities, Plan Design Requirements, Wellness Programs
Summary A set of Frequently Asked Questions addresses several issues of vital interest to employers in assessing the connection between COVID-19 vaccinations and their health plans. The Upshot The FAQs confirm that the preventive care rules under the Affordable Care Act (ACA) require health plans to cover the full cost of vaccinations that have received an emergency [&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 »
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