Health Care Reform Dashboard

Health Care Reform Dashboard

Charting Developments with the
Affordable Care Act and Beyond

Plan Design Requirements

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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The Equal Employment Opportunity Commission (EEOC) has formally withdrawn the provisions in its regulations governing wellness programs under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act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 »
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 »
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 »
12/28/2015

Further Guidance on ACA Market Reforms for Group Health Plans

Following up on the issuance of final regulations on various market reform provisions under the Affordable Care Act (ACA), the IRS has issued a notice with Questions and Answers that take a more detailed look at specific ACA issues. In particular, this notice addresses: Health reimbursement arrangements (HRAs). The guidance confirms that retiree-only HRAs may [&hellip… Continue Reading »
11/09/2015

EEOC Proposes Guidance on GINA, Wellness Program

The Equal Employment Opportunity Commission (EEOC) has followed up on proposed regulations that it issued this spring on wellness programs under the Americans with Disabilities Act (ADA) with a new set of proposed regulations on wellness programs under the Genetic Information Nondisclosure Act (GINA). Most significantly, the regulations provide relief with regard to an issue [&hellip… Continue Reading »
07/30/2015

Final Rules for Preventive Services

The U.S. Departments of Treasury, Labor (DOL) and Health and Human Services (HHS) have issued interim final regulations and Frequently Asked Questions and Answers on the cost-free coverage of preventive services under the Affordable Care Act (ACA). Although the regulations address many preventive care subjects, all of the attention has focused on the changes to [&hellip… Continue Reading »
05/26/2015

New Guidance on Cost-Sharing Limits and Provider Nondiscrimination Rules

The U.S. Departments of Labor, Health and Human Services, and the Treasury have jointly issued a new set of FAQs that clarifies the application of the rules establishing cost-sharing limits. For 2016, non-grandfathered group health plans must cap the amount that plan participants pay in deductibles, copayments, coinsurance and the like at $6,850 for self-only [&hellip… Continue Reading »
05/13/2015

Guidance Clarifies Certain Preventive Care Requirements

Recent guidance issued jointly by the U.S. Departments of Labor, Health and Human Services, and the Treasury clarifies how the Affordable Care Act’s requirement to provide cost-free coverage for preventive care applies to several types of products and services. In particular, the guidance clarifies that:  Coverage for all types of contraception (currently 18 different types are [&hellip… Continue Reading »
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