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 »
The IRS issued a new notice that provides guidance on a few issues that were not fully addressed in its earlier notice on the Consolidated Omnibus Budget Reconciliation Act (COBRA) premium subsidy requirements set forth in the American Rescue Plan Act (ARPA). ARPA generally requires the cost of coverage under COBRA between April 1, 2021, and September 30, 2021, to [&hellip… Continue Reading »
The U.S. Departments of the Treasury, Labor, and Health and Human Services, along with the federal Office of Personnel Management, have jointly issued interim final regulations under the No Surprises Act. The regulations elaborate on the already detailed requirements in the Act, which was signed into law in December as part of the Consolidated Appropriations Act, 2021. [&hellip… Continue Reading »
In a 7-2 decision, the Supreme Court rebuffed a challenge to the constitutionality of the Affordable Care Act, finding that the plaintiffs who challenged the ACA lacked standing to bring the lawsuit. The challenge arose under the individual shared responsibility provisions of the ACA, which originally required most taxpayers to pay a prescribed assessment if they did [&hellip… Continue Reading »
The U.S. Department of Health and Human Services (HHS) has announced that its Office for Civil Rights (OCR) will begin enforcing Section 1557 of the Affordable Care Act to prohibit discrimination based on sexual orientation and gender identity. Section 1557 prohibits many health care providers and certain health plans from discriminating against individuals on the [&hellip… Continue Reading »
Summary The IRS issued guidance on a wide range of questions pertaining to the subsidies that employers are required to offer to COBRA qualified beneficiaries under the American Rescue Plan Act. The Upshot The guidance follows up on prior U.S. Department of Labor guidance, is generally consistent with prior IRS guidance, and includes an extensive [&hellip… Continue Reading »
The IRS issued a notice that addresses many of the questions employers have raised about flexible spending accounts (FSAs) in view of the new rules set forth in the Consolidated Appropriations Act (CAA). The CAA provides temporary relief for concerns raised by the COVID-19 pandemic by allowing: 1. temporary expansions of the opportunity to carry [&hellip… Continue Reading »
Group health plan sponsors and administrators may soon need to introduce changes to their offer of continued coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). The House Education and Labor Committee has proposed temporary COBRA subsidies and other modifications as part of the current COVID-19 stimulus package that is working its way [&hellip… Continue Reading »
Summary The Equal Employment Opportunity Commission (EEOC) announced it will issue much-anticipated guidance that revises its nondiscrimination rules for wellness programs under the Americans with Disabilities Act (ADA) and Genetic Information Nondiscrimination Act (GINA). The Upshot The two sets of proposed regulations replace rules the EEOC withdrew in 2018 after a federal district court invalidated [&hellip… Continue Reading »
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 »
The U.S. Court of Appeals for the District of Columbia Circuit upheld the final regulations issued by the Trump administration that increased the availability of short term, limited duration insurance (STLDI). The regulations extended the period for which STLDI may be offered to 12 months, allowing it to be renewed twice for a total duration [&hellip… Continue Reading »
In Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, the Supreme Court this week upheld regulations issued by the U.S. Departments of Treasury, Labor, and Health and Human Services (the Departments) that exempted employers with sincerely held religious beliefs and employers with moral objections from the requirement to provide contraceptive coverage under [&hellip… Continue Reading »
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 »
The U.S. Supreme Court has determined that the federal government must pay over $12 billion to certain health insurers that participated in health insurance exchanges in the first three years that those exchanges were in effect. In Maine Community Health Options v. United States, the court ruled that health insurers that suffered financial losses beyond [&hellip… Continue Reading »
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 »
In a 2-1 decision, the Fifth Circuit Court of Appeals has upheld a district court ruling that the individual mandate under the Affordable Care Act is unconstitutional. However, the Fifth Circuit has sent the case back to the district court for further consideration on the extent to which the ruling invalidates other ACA provisions. The individual mandate [&hellip… Continue Reading »
Once again, the IRS has extended the deadline for furnishing Forms 1095-B and 1095-C to individuals. Reporting penalties will not apply to those who meet the applicable deadlines and complete the forms in good faith. The deadlines for reporting information for 2019 are: Deadline for providing Forms 1095-B and 1095-C to individuals: March 2, 2020 [&hellip… Continue Reading »
Federal executive agencies recently published two rules, one final and one proposed, aimed at publicizing the various costs associated with health care. A final rule, promulgated by the Department of Health and Human Services (HHS) via the Centers for Medicare & Medicaid Services (CMS), requires hospitals to establish, update, and publish online a list of [&hellip… Continue Reading »
The U.S. Department of the Treasury has issued proposed regulations addressing how individual coverage health reimbursement arrangements (ICHRAs) can comply with the Employer Shared Responsibility Payments (ESRP) requirements under the Affordable Care Act (ACA) and the nondiscrimination rules for self-funded medical plans under section 105(h) of the Internal Revenue Code. The proposed regulations follow a [&hellip… Continue Reading »
With all of the attention on Health Insurance Portability and Accountability Act (HIPAA) requirements to safeguard the privacy and security of a patient’s health information, covered entities sometimes overlook the HIPAA provisions that give patients rights to their information. This includes a patient’s right to access his or her medical and billing records from providers and [&hellip… Continue Reading »
The U.S. District Court for the District of Columbia upheld a rule that expanded the maximum length of time for short-term, limited duration insurance (STLDI). STLDI is coverage that lasts a limited period of time and is exempt from many of the requirements that apply to plans in the individual health insurance market. Concerned that STLDI [&hellip… Continue Reading »
Pursuant to a directive in last month’s Executive Order 13877, the Treasury Department issued guidance yesterday that lists particular preventive care items and services that may be covered by a high deductible health plan (HDHP) even before the deductible is satisfied. Many employers offer employees the opportunity to enroll in an HDHP with a health [&hellip… Continue Reading »
On June 24, 2019, President Trump signed Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First. This is the President’s third executive order affecting the health care industry. Executive Order 13813 issued in October 2017, set the regulatory agenda for Association Health Plans, Short-Term Limited-Duration Insurance, and Individual Coverage Health Reimbursement [&hellip… Continue Reading »
