Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Brian M. Pinheiro

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

By Brian M. Pinheiro, Edward I. Leeds and Paige A. Haughton on 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 »

Upcoming Compliance Deadlines for Health and Welfare Plans

By Brian M. Pinheiro, Edward I. Leeds and Paige A. Haughton on 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 »

Keeping Up With No Surprises

By Jean C. Hemphill, Brian M. Pinheiro, Edward I. Leeds and Jessica M. DuBois on 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 »

COBRA Premium Assistance

By Edward I. Leeds and Brian M. Pinheiro on Posted in COBRA
The United States Department of Labor has issued much anticipated guidance and model forms under the COBRA subsidy rules introduced by the American Rescue Plan (ARP). The FAQ guidance and forms clarify some issues that employers have raised about the COBRA subsidy provisions of the ARP, but leave a number of the most significant questions unanswered. Clarifications and confirmations [&hellip… Continue Reading »

New Stimulus Deal: Overview of Major Provisions Impacting Businesses and Individuals

By Edward I. Leeds, Brian M. Pinheiro, Brian D. Pedrow and John Devine on Posted in Healthcare, Legislation
President Trump signed additional COVID-19 relief legislation (H.R. 133) into law on December 27, 2020. The deal includes a $900 billion economic stimulus package that will provide relief benefits to businesses and individuals impacted by the COVID-19 pandemic. The following is a summary of some of the provisions that will have a major impact: Financial [&hellip… Continue Reading »

Supreme Court Finds ERISA Does Not Preempt State Prescription Drug Pricing Law

By Edward I. Leeds and Brian M. Pinheiro on Posted in Health Plans, Healthcare Providers / Suppliers, Legislation
Summary The U.S. Supreme Court unanimously upheld an Arkansas statute that regulates the price that pharmacy benefit managers (PBMs) pay retail pharmacies for prescription drugs. The Upshot Act 900 in Arkansas regulates the price paid by PBMs for the cost of drugs purchased at retail pharmacies through mechanisms designed to ensure that the pharmacy would [&hellip… Continue Reading »

Court Issues Injunction Against Revised ACA Nondiscrimination Rules

By Brian M. Pinheiro, Edward I. Leeds and Paige A. Haughton on Posted in Healthcare, Legislation, Non-discrimination Rules
The U.S. District Court for the Eastern District of New York issued an order on Monday (August 17, 2020) that prevented federal rules removing nondiscrimination protections from taking effect. The rules would have removed protections against discrimination based on gender identity and sex stereotyping from the nondiscrimination provision within the Patient Protection and Affordable Care Act (ACA). [&hellip… Continue Reading »

CMS Scales Back ACA Nondiscrimination Rules

By Edward I. Leeds and Brian M. Pinheiro on Posted in Health Plans, Healthcare Providers / Suppliers, Nondiscrimination
The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has finalized rules that narrow and eliminate various nondiscrimination requirements under Section 1557 of the Affordable Care Act (Act). Section 1557 prohibits certain health care providers, health benefit plans, and health insurers from discriminating against individuals on account [&hellip… Continue Reading »

IRS Increases Carryover Limits for Health FSAs/Addresses Timing of Health Insurance

By Edward I. Leeds, G'nece Jones and Brian M. Pinheiro on Posted in Health Plans, Individual Coverage Mandate, Plan Design Requirements, Stand-Alone HRAs
The Internal Revenue Service (“IRS”) has issued new guidance, Notice 2020-33, that increases the maximum carryover limit for health flexible spending arrangements (“health FSAs”), and clarifies the ability of health plans to reimburse premium expenses incurred prior to the beginning of the plan year. Increased Carryover Limit Health FSAs generally operate on a use-it-or-lose-it basis. [&hellip… Continue Reading »

SECURE Act In; Cadillac Tax Out: The Spending Act Makes Serious Changes to Benefits Rules

By Jean C. Hemphill, Edward I. Leeds, Brian M. Pinheiro, Diane A. Thompson, Joshua T. Natzel and Ada B. Okafor on Posted in Cadillac Tax, Health Insurance Providers, Health Plans, Healthcare Providers / Suppliers, Legislation, Medical Devices, PCORI, Taxes and Fees
President Trump signed into law a nearly $1.4 trillion spending package that avoided a government shutdown and will fund the government through September 30, 2020. The year-end spending package, signed December 20, 2019, contains a number of retirement and health and welfare provisions that will be of interest to employers and other plans sponsors and [&hellip… Continue Reading »

New Tax Cuts and Jobs Act Affects Employee Benefit Plans and Executive Compensation Arrangements

By Brian M. Pinheiro on Posted in Individual Coverage Mandate, Legislation
The Tax Cuts and Jobs Act, signed into law by President Donald J. Trump shortly before Christmas, is the most significant tax reform legislation in more than 30 years. While early versions of the legislation would have made sweeping changes to employee benefit plans and executive compensation arrangements, the final Act has a narrower, though [&hellip… Continue Reading »

ACA Repeal and Replace Plan is Released

By Jean C. Hemphill, Brian M. Pinheiro, Brenda M. Ching and Edward I. Leeds on Posted in Health Plans, Healthcare Providers / Suppliers, Legislation
The House Ways and Means and Energy and Commerce Committees have released, in two parts, budget reconciliation legislation, the first steps of Congress’ proposal to “repeal and replace” the Affordable Care Act. Reconciliation legislation is limited to budget-related provisions and restricts legislators’ ability to address fully all of the repeal and replacement provisions that we [&hellip… Continue Reading »

IRS Issues Second Guidance on Cadillac Tax

By Kurt R. Anderson, Edward I. Leeds and Brian M. Pinheiro on Posted in Cadillac Tax, Taxes and Fees
The Internal Revenue Service has issued a new notice addressing issues relating to future rules governing the calculation and payment of the so-called “Cadillac tax” under the Affordable Care Act. Beginning in 2018, the ACA will impose a 40 percent nondeductible excise tax on the value of group health coverage that exceeds a baseline amount [&hellip… Continue Reading »

Supreme Court Upholds Affordable Care Act Subsidies in King v. Burwell

By Brian M. Pinheiro, Jean C. Hemphill, Diane A. Thompson, Edward I. Leeds and Christopher W. Welsch on Posted in Employer Mandate/Shared Responsibility (Pay or Play), Litigation, Premium Tax Credit, State Exchanges
In a much-anticipated decision, the U.S. Supreme Court ruled today that individuals who enroll for coverage in a health insurance exchange may qualify for a subsidy to make that coverage more affordable, regardless of whether the exchange is established by the federal or a state government. The 6-3 decision in King v. Burwell upholds the [&hellip… Continue Reading »

New Guidance on Affordable Care Act Reporting Requirements

By Edward I. Leeds, Brian M. Pinheiro, Jean C. Hemphill and Diane A. Thompson on Posted in Employer Responsibilities, Reporting
The Internal Revenue Service has issued two lengthy sets of questions and answers on the requirement under the Affordable Care Act that employers report on their compliance with the employer mandate and employees’ qualification for exchange subsidies. The new guidance is divided into general information about the reporting rules and information about completing the actual [&hellip… Continue Reading »

Update on Summary of Benefits and Coverage Notices for Plan Years 2016 and 2017

By Jean C. Hemphill, Brian M. Pinheiro, Diane A. Thompson, Edward I. Leeds and Sharon M. Marshall on Posted in Employee Notices, Employer Responsibilities, Summary of Benefits and Coverage
In a new frequently asked question (FAQ) released by the U.S. Departments of Labor (DOL), Treasury, and Health and Human Services on March 30, 2015, the agencies advised the public that they intend to finalize the summary of benefits and coverage (SBC) regulations (proposed on December 30, 2014 and described below) in time to apply [&hellip… Continue Reading »

IRS Issues Preliminary Guidance on Cadillac Tax

By Brian M. Pinheiro, Edward I. Leeds, Brian D. Pedrow and Daniel V. Johns on Posted in Cadillac Tax, Taxes and Fees
Yesterday, the Internal Revenue Service issued preliminary but much-anticipated guidance on the so-called Cadillac tax imposed by the Affordable Care Act (ACA). The new notice offers very few concrete answers to employer questions about how the tax is to be calculated. Mostly, the IRS identifies issues that may be the subject of future proposed regulations, [&hellip… Continue Reading »

Expatriate Plans Exempted from Many Affordable Care Act Provisions

By Edward I. Leeds, Brian M. Pinheiro, Jean C. Hemphill and Diane A. Thompson on Posted in Employer Mandate/Shared Responsibility (Pay or Play), Employer Responsibilities, Excepted Benefit Plans, Plan Design Requirements, Reporting
In the Consolidated and Further Continuing Appropriations Act (the recently enacted federal budget bill often known as the “CRomnibus” legislation), Congress has exempted health plans designed to cover expatriates from most of the requirements of the Affordable Care Act. The exemption will generally apply where a group health plan provides significant health coverage and substantially [&hellip… Continue Reading »

Government Agencies Release Further Accommodations to Organizations Opposing Mandated Contraceptive Coverage

By Jean C. Hemphill and Brian M. Pinheiro on Posted in Employer Mandate/Shared Responsibility (Pay or Play), Essential Benefits, Litigation, Plan Design Requirements, Preventive Services, State Exchanges
In response to the recent U.S. Supreme Court decision in Burwell v. Hobby Lobby, Inc., the U.S. Departments of Health and Human Services (HHS) and Labor (DOL) published proposed rules on August 22, 2014, expanding the availability of the religious accommodation to the contraceptive mandate provided in their July 2013 final regulations to closely held [&hellip… Continue Reading »

Federal Courts Make Conflicting Rulings on Premium Assistance for Federal Exchange Plan Participants

By Jean C. Hemphill, Diane A. Thompson, Brian M. Pinheiro, Edward I. Leeds and Alisa M. Huth on Posted in Litigation
Does the Affordable Care Act (ACA) authorize the payment of premium and copayment subsidies, or “premium assistance subsidies,” to individuals enrolled in a federally established Exchange? On July 22, 2014, two federal courts issued conflicting opinions on this subject. The U.S. Court of Appeals for the District of Columbia Circuit, in Halbig v. Burwell, concluded [&hellip… Continue Reading »

Religious Freedom Law Exempts Employers from ACA Contraceptive Mandate, Supreme Court Holds

By Brian M. Pinheiro, Jean C. Hemphill and Edward I. Leeds on Posted in Litigation
The U.S. Supreme Court has ruled in favor of three for-profit corporations that claimed that the Affordable Care Act (ACA) mandate to provide preventive care coverage for certain types of contraception violated the protections afforded to them under the federal Religious Freedom Restoration Act of 1993 (RFRA). This ruling is expected to apply primarily to [&hellip… Continue Reading »

Religious Freedom Law Exempts Employers from ACA Contraceptive Mandate, Supreme Court Holds

By Brian M. Pinheiro, Jean C. Hemphill and Edward I. Leeds on Posted in Litigation, Plan Design Requirements, Preventive Services
The U.S. Supreme Court has ruled in favor of three for-profit corporations that claimed that the Affordable Care Act (ACA) mandate to provide preventive care coverage for certain types of contraception violated the protections afforded to them under the federal Religious Freedom Restoration Act of 1993 (RFRA). This ruling is expected to apply primarily to [&hellip… Continue Reading »

New FAQs Address Effect of Affordable Care Act on COBRA and Other Matters

By Jean C. Hemphill, Edward I. Leeds, Sharon M. Marshall, Brian M. Pinheiro and Diane A. Thompson on Posted in Employee Notices, Employer Responsibilities, Essential Benefits, Excepted Benefit Plans, Exchange Notice, Flexible Spending Accounts (FSAs), Grandfathered Plans, Individual Coverage Mandate, Plan Design Requirements, Preventive Services, Summary of Benefits and Coverage
In a wide-ranging set of frequently asked questions (FAQs) and other guidance, the U.S. Departments of Labor, Treasury, and Health and Human Services have addressed a number of issues pertaining to the Affordable Care Act (ACA). They include issues pertaining to COBRA and the Children’s Health Insurance Program Reauthorization Act (CHIPRA), annual cost-sharing limits, preventive care, [&hellip… Continue Reading »
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