Although much of our attention this fall was focused on the government shutdown, health plan sponsors may be interested in several less-publicized developments affecting group health plans. The Upshot The Bottom Line The two lawsuits and the administrative guidance, along with factors affecting the cost of health coverage, bear watching as each of these matters [&hellip… Continue Reading »
A recent federal district court decision has upheld an Arkansas Insurance Department rule that requires health benefit plans to submit certain pharmacy compensation information to the Department. The court ruled that this reporting requirement is not preempted by ERISA, finding that the rule does not apply exclusively to ERISA plans and that the reporting required by the rule [&hellip… Continue Reading »
The Fifth Circuit and the Federal District Court of Connecticut have issued conflicting decisions on whether service providers may sue to enforce arbitration awards under the No Surprises Rules in the Consolidated Appropriations Act, 2021. While the Connecticut court found that a service provider may request a court to order an insurance company to pay [&hellip… Continue Reading »
Two recent U.S. Supreme Court rulings support provisions of the Affordable Care Act, one directly and one indirectly. The Upshot The Bottom Line Plans will need to continue to provide 100 percent coverage for preventive health services with an A or B recommendation from the USPSTF. Based on the Court’s ruling, federal district courts will [&hellip… Continue Reading »
Summary Following the U.S. Supreme Court’s decision to overturn its Chevron decision three district courts have struck down provisions in nondiscrimination regulations under the Affordable Care Act that prohibit discrimination based on gender identity. in what constitutes unlawful discrimination. The Upshot The Bottom Line The full impact of the Loper Bright and Corner Post decisions [&hellip… Continue Reading »
Summary The rules in the Consolidated Appropriations Act that aim to eliminate much of the surprise from billings by out-of-network providers in particular situations are the subject of continued controversy. The Upshot The Bottom Line If upheld, the district court’s decisions will likely result in higher costs for plans and patients, but there remains much [&hellip… Continue Reading »
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 »
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 »
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. 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 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 »
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 »
After announcing that its HIPAA enforcement collections had reached a new high-water mark of $28.7 million in 2018, the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services has started this year quietly. Through the first few months of 2019, the OCR has published no resolution agreements and it is [&hellip… Continue Reading »
The U.S. District Court for the District of Columbia has set aside the most significant portions of the U.S. Department of Labor’s (DOL) regulations on Association Health Plans (AHPs). The court’s ruling invalidates regulatory provisions that sought to broaden the groups of employers that could be treated as if they were a single employer, allowing [&hellip… Continue Reading »
The Affordable Care Act returned to the front page this weekend when a federal district court in Texas issued an opinion striking down the entire law as unconstitutional. The case arose from a lawsuit filed by a contingent of Republican state attorneys general, one governor, and a few individuals. They asserted that Congress’s elimination of [&hellip… Continue Reading »
After a brief lull in activity, recent developments are likely to involve all three branches of government in addressing issues under the Affordable Care Act. The Legislature: It is often said that Congress rarely takes action until a crisis needs to be addressed. With the demise of this summer’s repeal and replace effort, initiatives to [&hellip… Continue Reading »
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 »
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 »
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 »
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 »
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 »
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 »
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 »
