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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
Summary The IRS has extended certain deadlines relating to affordable housing projects with Low Income Housing Tax Credits (LIHTC) under Section 42 of the Internal Revenue Code of 1986, as amended (the Code) or financed with tax-exempt private activity bonds under Section 142(d) of the Code. The Upshot While COVID-19 disruptions continue, owners, operators, issuers, and state [&hellip… Continue Reading »
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 »
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 »
After the Supreme Court blocked President Biden’s vaccine-or-testing mandate for private companies, The Philadelphia Inquirer spoke with Shannon Farmer about where things stand. Ms. Farmer is a member of Ballard Spahr’s Labor and Employment Group. Read the full article here. (Subscription may be required.)… Continue Reading »
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 »
Today’s episode features a discussion of how employers should handle leaves and requests for leave due to COVID-19 and “long COVID” under the FMLA (the Family and Medical Leave Act) and the ADA (the Americans with Disabilities Act). Participating in this discussion are Melissa Costello, Of Counsel in Ballard’s Phoenix office, Tara Humma, an Associate [&hellip… Continue Reading »
Summary On January 13, 2022, the Supreme Court “split the baby” on two federal vaccine mandates. The Court stayed the OSHA “vaccine or test” rule, but allowed the Centers for Medicare & Medicaid Services (CMS) vaccine mandate for health care workers to take effect. Employers now must wrestle with the complex impact of these decisions [&hellip… Continue Reading »
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 »
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 »
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 »
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 »
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 »
Summary Three federal agencies, the Departments of Labor, Health and Human Services, and Treasury, jointly released new FAQs on August 20, 2021, regarding compliance with new health plan disclosure requirements of the Transparency in Coverage Final Rules (TiCFR), the No Surprises Act, and additional transparency provisions under the Consolidated Appropriations Act (CAA). In the FAQs, [&hellip… Continue Reading »
