Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

D. Finn Pressly

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Details Upon Details: Compliance under MHPAEA’s New Proposed Regulations

By Edward I. Leeds, D. Finn Pressly and Uchenna J. Osagiede on 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

By D. Finn Pressly, Edward I. Leeds and Uchenna J. Osagiede on 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 »

Meet me at the Corner of No Surprises and …

By D. Finn Pressly and Edward I. Leeds on 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

By D. Finn Pressly, Edward I. Leeds and Rachel Loscheider on 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

By Edward I. Leeds, Rachel Loscheider and D. Finn Pressly on 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

By Edward I. Leeds and D. Finn Pressly on 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

By D. Finn Pressly, Edward I. Leeds and Uchenna J. Osagiede on 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

By Edward I. Leeds and D. Finn Pressly on 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 »

Strike Two: Court Again Invalidates No Surprises Procedure

By D. Finn Pressly and Edward I. Leeds on 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

By D. Finn Pressly and Edward I. Leeds on 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 »

IRS Finalizes Affordable Care Act Reporting Relief

By Kimberly L. Steefel, D. Finn Pressly and Edward I. Leeds on 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 »

Last-Minute Reprieve for HSA-Compatible Telehealth Benefits

By D. Finn Pressly on Posted in Consolidated Appropriations Act (CAA), Health Plans, Legislation
With little time to spare before the provisions expired, Congress has extended, and President Biden is set to sign into law, an important safe harbor that allows plan sponsors to continue offering reduced-cost telehealth services without disrupting the ability to contribute to health savings accounts (HSAs). The extension is part of the $1.7 trillion Consolidated [&hellip… Continue Reading »

Dispute Resolution Process is Modified Under the CAA’s No Surprise Billing Rules

By Jean C. Hemphill, D. Finn Pressly and Edward I. Leeds on 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 »
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