Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Plan Design Requirements

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10/07/2021

HHS Clarifies Applicability of HIPAA Privacy Rule to COVID-19 Vaccination Status Requests

The U.S. Department of Health and Human Services (HHS) has released guidance to address how the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule applies to various entities’ requests for information related to an individual’s COVID-19 vaccination status. HHS emphasized that the Privacy Rule applies only to covered entities, including health plans and most [&hellip… Continue Reading »
10/06/2021

COVID-19 Vaccination Incentives: Restrictions that Come with Rewards

Summary A set of Frequently Asked Questions addresses several issues of vital interest to employers in assessing the connection between COVID-19 vaccinations and their health plans. The Upshot The FAQs confirm that the preventive care rules under the Affordable Care Act (ACA) require health plans to cover the full cost of vaccinations that have received an emergency [&hellip… Continue Reading »
10/06/2021

Keeping Up With No Surprises

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 »
08/25/2021

Enforcement Delayed Under the New Health Plan Disclosure Requirements

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 »
01/13/2021

A Second Proposal: EEOC Issues New Guidance on Nondiscrimination for Wellness Programs

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 »
12/09/2020

Year-End COVID-19 Considerations for Health and Welfare Plans

Summary COVID-19 has dominated the agenda for health and welfare benefits in 2020. From suspended deadlines to mid-year election changes to enhanced cost-free coverage, the pandemic has resulted in significant changes to the design and operation of many health and welfare plans. As the year comes to a close, employers should consider whether they have [&hellip… Continue Reading »
05/15/2020

IRS Increases Carryover Limits for Health FSAs/Addresses Timing of Health Insurance

The Internal Revenue Service (“IRS”) has issued new guidance, Notice 2020-33, that increases the maximum carryover limit for health flexible spending arrangements (“health FSAs”), and clarifies the ability of health plans to reimburse premium expenses incurred prior to the beginning of the plan year. Increased Carryover Limit Health FSAs generally operate on a use-it-or-lose-it basis. [&hellip… Continue Reading »
10/16/2019

Proposed Regulations Provide Additional Guidance on Individual Coverage HRAs

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 »
07/26/2019

U.S. District Court Upholds Short-Term Limited Duration Insurance Rule

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 »
07/02/2019

Executive Order Aims to Enhance Transparency in Health Care Costs and Quality

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 »
06/19/2019

Coming to Market: Final Rules for Individual Coverage HRAs

The U.S. Departments of the Treasury, Labor, and Health and Human Services have issued final regulations allowing employers to establish health reimbursement arrangements and certain other types of reimbursement plans (collectively, “individual coverage HRAs”) that integrate with individual health insurance coverage. Individual coverage HRAs (ICHRAs) present an alternative to traditional group health coverage and allow employers to [&hellip… Continue Reading »
12/20/2018

EEOC Withdraws Wellness Incentive Guidance

The Equal Employment Opportunity Commission (EEOC) has formally withdrawn the provisions in its regulations governing wellness programs under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), which set limits on the amount of incentives for participation in a wellness program. This withdrawal aligns the regulations with a court order that [&hellip… Continue Reading »
11/21/2018

IRS Issues Additional Guidance on Health Reimbursement Arrangements

The IRS has followed up on its recently proposed Health Reimbursement Arrangements (HRA) regulations with guidance on some open issues. Notice 2018-88 specifically addresses the interplay between HRAs and two Internal Revenue Code requirements: the employer mandate under the Affordable Care Act (Code Section 4980H) and the nondiscrimination rules for self-funded health plans (Code Section 105(h)). Employer [&hellip… Continue Reading »
10/24/2018

New Guidance Creates a New Playing Field for HRAs

The U.S. Departments of the Treasury, Labor, and Health and Human Services have jointly issued proposed regulations that envision a broad landscape for the use of health reimbursement arrangements (HSAs) and certain other account-based plans to fund health benefits. The rules provide the last and, perhaps, the most significant set of guidance generated by an Executive [&hellip… Continue Reading »
08/03/2018

Final Regulations Expand Availability of Individual Insurance Not Meeting ACA Requirements

The U.S. Departments of the Treasury, Labor, and Health and Human Services have jointly issued final rules modifying the definition of short-term, limited-duration insurance (STLDI). STLDI provides health coverage that is intended to be transitional in nature. It is not regarded as individual health insurance or minimum essential coverage and is exempt from certain Affordable [&hellip… Continue Reading »
06/22/2018

DOL Releases Final Regulation Expanding Association Health Plans

The U.S. Department of Labor (DOL) on Tuesday released final regulations modifying the Association Health Plan (AHP) rules to expand their availability for small and large employers and to address their affordability by eliminating certain coverage requirements applicable to qualified health plans under the Affordable Care Act (ACA). The regulations aim to balance the need [&hellip… Continue Reading »
01/10/2018

DOL Proposes Expansion of Association Health Plans

Following up on the direction provided by Executive Order 13813, the U.S. Department of Labor (DOL) has issued proposed regulations that would expand the ability of small employers to band together and provide coverage under a single Association Health Plan (AHP). Under the new rules: AHPs may be formed by employers that are engaged in [&hellip… Continue Reading »
10/19/2017

Developments in the Affordable Care Act

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 »
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 »
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 »
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 »
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