Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Health Plans

Subscribe to Health Plans RSS Feed
03/08/2017

ACA Repeal and Replace Plan is Released

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 »
01/23/2017

Data Breach Class Action Reinstated Against Horizon Healthcare Services, Inc.

The U.S. Court of Appeals for the Third Circuit has vacated a district court’s dismissal of a data breach class action filed against Horizon Healthcare Services Inc., in the wake of the 2013 theft of two computer laptops containing unencrypted personal information of Horizon Healthcare plan members. The decision potentially expands the circumstances under which [&hellip… Continue Reading »
01/20/2017

Health Care Reform in Transition While Congress Deliberates

Changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting the health care industry. Ballard Spahr attorneys established a Health Care Reform Initiative in 2008 to monitor and analyze health care reform developments. This Health Care Reform Dashboard was a product of that initiative. We intend to continue following [&hellip… Continue Reading »
12/16/2016

EEOC Releases Guidance on Mental Health Discrimination

The Equal Employment Opportunity Commission (EEOC) has issued guidance reminding employers that it is illegal under the Americans with Disabilities Act (ADA) and other laws to discriminate against an employee simply because he or she has a mental health condition. This includes firing an employee, rejecting an employee for a job or promotion, and forcing [&hellip… Continue Reading »
12/15/2016

Obama Signs 21st Century Cures Act, Adding $6.3 Billion For Medical Research

President Obama has signed into law the 21st Century Cures Act. Enacted with overwhelming bipartisan support, the Cures Act: Authorizes more than $6.3 billion in funding for medical research and drug development programs; Provides for new programs and increased funding for mental health treatment and substance use disorder programs; and Includes various Medicare provisions sought [&hellip… Continue Reading »
12/02/2016

OCR Warns of Phishing as Business Associate Audits Begin

The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) has posted an alert (and a follow-up alert) warning health plans, health care providers, and their vendors of a mock communication involving the OCR audit program under the Health Insurance Portability and Accountability Act (HIPAA). The email falsifies HHS departmental letterhead [&hellip… Continue Reading »
11/30/2016

Beware of Phishing Email Disguised as Official OCR Audit Communication

The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) has posted an alert (and a follow-up alert) warning health plans, health care providers, and their vendors of a mock communication involving the OCR audit program under the Health Insurance Portability and Accountability Act (HIPAA). The email falsifies HHS departmental [&hellip… Continue Reading »
11/21/2016

IRS Extends ACA Reporting Deadline

The IRS has extended the deadline for furnishing 2016 Forms 1095-C and 1095-B to individuals by 30 days to March 2, 2017. The reprieve offers welcome relief to employers, health insurers, and other plan sponsors who would otherwise have been required to distribute these forms under the Affordable Care Act (ACA) by January 31, 2017. [&hellip… Continue Reading »
11/07/2016

Final Regulations on Short-Term Health Plans Under the Affordable Care Act

The U.S. Departments of Labor, Health and Human Services, and the Treasury have finalized regulations under the Affordable Care Act (ACA) that address certain exceptions under the ACA. Among other things, the regulations: Define “essential health benefits” for purposes of identifying plans that are (and are not) subject to the ACA prohibition against annual and [&hellip… Continue Reading »
11/05/2016

Guidance Addresses Mental Health Parity

The U.S. Departments of Labor, Health and Human Services, and the Treasury have issued a set of Frequently Asked Questions and Answers that, among other things, implement certain of the recommendations included in a report issued by the White House Mental Health and Substance Use Disorder Parity Task Force. This guidance manifests the administration’s continuing [&hellip… Continue Reading »
11/04/2016

HHS Designates Cloud Service Providers as Business Associates Under HIPAA

Cloud service providers that process electronic protected health information (ePHI) are business associates under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), even if the PHI is encrypted and the cloud service provider is not able to view it. This unequivocal determination, made in recent guidance by the U.S. Department of Health and [&hellip… Continue Reading »
10/24/2016

Temporary Relief for Certain Student Health Plans Extended Indefinitely

In recently issued guidance, the U.S. Departments of Treasury, Labor, and Health and Human Services indicated that they will indefinitely extend relief to colleges and universities that subsidize the cost of individual insurance premiums for student employees. Under previously issued guidance, a health reimbursement arrangement or other program that pays some or all of the premium [&hellip… Continue Reading »
09/27/2016

Hot Topics in Employer Health Benefits

As we start looking forward to 2017, and as many employers head into annual enrollment periods this fall, it is necessary to account for changes in the law that have a significant impact on health benefit plans. This short list of significant developments may help you prepare for what is coming: Affordable Care Act (ACA) Reporting. The [&hellip… Continue Reading »
08/08/2016

IRS Proposes Adjustments in Individual Mandate Reporting

The IRS has issued proposed regulations on the individual mandate reporting requirements under section 6055 of the Internal Revenue Code. To a significant degree, the new regulations reflect guidance previously published by the IRS. Although the rules are only proposed, health plan sponsors may generally rely on them now. The new guidance addresses several discrete [&hellip… Continue Reading »
07/25/2016

OCR Announces First HIPAA Enforcement Action Against a Business Associate

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) announced an agreement with Catholic Health Services of the Archdiocese of Philadelphia (CHCS), settling allegations that CHCS violated the Health Insurance Portability and Accountability Act (HIPAA) Security Rule by failing to protect electronic protected health information (ePHI). This is the first enforcement [&hellip… Continue Reading »
07/25/2016

Check Your Desk: HIPAA Audits for Covered Entities Have Arrived

The Office of Civil Rights (OCR) of the Department of Health and Human Services has moved forward with Phase 2 of its Health Insurance Portability and Accountability Act of 1996 (HIPAA) audit program. On Monday, July 11, 2016, OCR sent emails to 167 covered entities (including health plans, health care, and health care clearinghouses) notifying them [&hellip… Continue Reading »
06/03/2016

ACA Nondiscrimination Regulations Finalized

The U.S. Department of Health and Human Services (HHS) has issued final regulations under Section 1557 of the Affordable Care Act (ACA) which prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. To be subject to these nondiscrimination rules, the health program or activity [&hellip… Continue Reading »
05/25/2016

EEOC Finalizes Wellness Program Regulations

The Equal Employment Opportunity Commission has published final regulations and a set of questions and answers on how the Americans with Disabilities Act (ADA) applies to employer-sponsored wellness programs that offer employees incentives to respond to disability-related inquiries or undergo medical examinations. At the same time, the EEOC published final regulations and a set of [&hellip… Continue Reading »
04/19/2016

HIPAA Audits Coming Your Way — Are You Ready?

The Office of Civil Rights (OCR) of the Department of Health and Human Services has begun Phase 2 of its audit program under the Health Insurance Portability and Accountability Act (HIPAA). In this phase, OCR will: ·       Collect contact information from covered entities and their business associates; ·       Audit selected covered entities and, later, business [&hellip… Continue Reading »
03/04/2016

Supreme Court Restricts State Medical Claims Data Reporting Law

ERISA does not allow a state to compel a self-insured group health plan to compile and report medical claims data for inclusion in a state-wide all-payer health care database, the U.S. Supreme Court has ruled in a landmark decision. In Gobeille v. Liberty Mutual Insurance Co., the Supreme Court backed the contention of Liberty Mutual [&hellip… Continue Reading »
03/02/2016

DOL Issues Proposed Updates for Summaries of Benefits and Coverage

The U.S. Department of Labor (DOL) has issued an updated template Summary of Benefits and Coverage (SBC), Glossary of Coverage and Medical Terms, and related materials. The revised materials remain in proposed form, but have been sent to the U.S. Office of Management and Budget with a request that the templates and glossary be approved [&hellip… Continue Reading »
02/11/2016

Temporary Relief for Certain Student Health Plans

In recent guidance, the U.S. Departments of Treasury, Labor , and Health and Human Services have extended transitional relief to colleges and universities that subsidize the cost of individual insurance premiums for student employees. Under previously issued guidance, a health reimbursement arrangement or other program that pays some or all of the premium for individual [&hellip… Continue Reading »
01/27/2016

Wellness Program Exempted from ADA

A federal district court in Wisconsin has upheld an employer-sponsored wellness program against a challenge by the Equal Employment Opportunity Commission (EEOC) that the program violated the Americans with Disabilities Act (ADA). In EEOC v Flambeau, the court ruled that the wellness program qualified for a safe harbor under the ADA that permits an employer [&hellip… Continue Reading »
.