Regulations under Section 1557 of the Affordable Care Act and HIPAA will require health plans and health care providers to take action in the coming months to meet new requirements. Health plan sponsors and providers that...more
The Fifth Circuit Court of Appeals has affirmed the invalidity of regulations governing the independent review process under the No Surprise Billing Rules....more
Following the U.S. Supreme Court’s recent decision to overturn its landmark 1984 Chevron decision, three district courts have struck down provisions in nondiscrimination regulations under the Affordable Care Act that prohibit...more
8/1/2024
/ Affordable Care Act ,
Biden Administration ,
Chevron Deference ,
Civil Rights Act ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Gender Identity ,
Health Insurance ,
LGBTQ ,
Loper Bright Enterprises v Raimondo ,
New Regulations ,
Non-Discrimination Rules ,
Preliminary Injunctions ,
SCOTUS ,
Sex Discrimination ,
Statute of Limitations ,
Statutory Interpretation ,
Title IX
Over the course of the past few months, the Office of Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC), both of which are divisions of the U.S. Department of Health and...more
6/28/2024
/ Cyber Attacks ,
Cybersecurity ,
Data Breach ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
HIPAA Breach ,
Information Technology ,
OCR ,
ONC ,
Personally Identifiable Information ,
PHI ,
Reproductive Healthcare Issues
The U.S. Department of Health and Human Services (HHS) has issued final regulations on the nondiscrimination rules set forth in Section 1557 of the Affordable Care Act. The new rules apply to certain group health plans, as...more
6/19/2024
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employees ,
Employer Liability Issues ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare ,
Medicare ,
New Rules ,
Proposed Rules ,
Sex Discrimination
The Biden administration has issued two sets of final regulations that overturn rules adopted during the Trump administration pertaining to association health plans and short-term, limited-duration insurance (STLDI). The...more
The Commonwealth of Pennsylvania changed its tax treatment of assistance that employers provide for dependent care services – including dependent care flexible spending accounts. Retroactive to January 1, 2023, Pennsylvania...more
You are the HIPAA privacy official of a hospital or health plan (a covered entity under HIPAA). You receive an email from a vendor that handles protected health information (a business associate), informing you that one month...more
1/5/2024
/ Cybersecurity ,
Data Breach ,
Data Privacy ,
Data Protection ,
Data Security ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Personally Identifiable Information
The United States Department of Health and Human Services (HHS) has filed court pleadings stating that it does not intend to initiate enforcement actions against plans that maintain copay accumulator programs....more
12/11/2023
/ Affordable Care Act ,
Co-payments ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employees ,
Employer Group Health Plans ,
Enforcement Guidance ,
Final Rules ,
Health Insurance ,
Healthcare ,
Non-Enforcement ,
Pharmaceutical Industry ,
Prescription Drugs ,
Rulemaking Process
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....more
10/24/2023
/ Billing ,
Consolidated Appropriations Act (CAA) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Life Sciences ,
Medical Bills ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Surprise Medical Bills
Summary -
Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision....more
10/18/2023
/ Affordable Care Act ,
Benefit Plan Sponsors ,
Co-payments ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employees ,
Health Insurance ,
Out-of-Pocket Expenses ,
Prescription Drug Coverage ,
Prescription Drugs ,
Subsidies ,
Third-Party
Summary -
The Departments of Labor, Health and Human Services, and the Treasury have proposed regulations under the Mental Health Parity Act that build on prior guidance to set forth requirements for an extremely detailed...more
8/16/2023
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Health Insurance ,
Healthcare ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Regulation ,
Proposed Rules ,
U.S. Treasury
Summary -
On July 25, 2023, the Departments of Labor, Treasury, and Health & Human Services (the Departments) released joint proposed regulations and other guidance under the Paul Wellstone and Pete Domenici Mental Health...more
8/1/2023
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Health Insurance ,
Healthcare ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Regulation ,
Proposed Rules ,
U.S. Treasury
Summary -
By December 31, 2023, health plans and insurers must submit an attestation of compliance with the anti-gag rules of the Consolidated Appropriations Act, 2021 (CAA). The rules apply to all agreements entered into...more
7/21/2023
/ Attestation Deadlines ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Gag Clauses ,
Health Care Providers ,
Health Insurance ,
HRA ,
Internal Revenue Code (IRC) ,
U.S. Treasury
The Departments of Labor, Health and Human Services, and the Treasury have published a set of proposed rules that impose new limits on two types of benefits: short-term limited-duration insurance (STLDI) and fixed indemnity...more
Summary -
The Departments of Labor, Health and Human Services, and the Treasury have issued guidance that coordinates application of the No Surprise Billing rules under the Consolidated Appropriations Act, 2021, with the...more
The Internal Revenue Service (IRS) has issued new guidance, Notice 2023-37, which states that for plan years ending after December 31, 2024, HSA-compatible high-deductible health plans (HDHPs) will no longer be permitted to...more
The Fifth Circuit Court of Appeals has stayed the broad application of a district court decision that would have invalidated a number of preventive care requirements under the Affordable Care Act. As a result, health plans,...more
Health plan sponsors and health insurers will need to report prescription drug and other health plan costs (RxDC reporting) for 2022 by June 1, 2023. Unlike the RxDC reporting requirements for 2020 and 2021, this deadline is...more
Summary -
The Departments of Labor, the Treasury, and Health and Human Services have jointly issued FAQs that address the requirement to cover the full cost of certain preventive care services in view of the recent ruling...more
4/19/2023
/ Advisory Committee ,
Affordable Care Act ,
Biden Administration ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Health Insurance ,
Healthcare ,
HRSA ,
New Guidance ,
Preventive Health Care
The State of Washington appears close to enacting a new law that regulates the privacy of consumer health information. If passed, the new law – the My Health My Data Act (MHMDA) –would take effect March 31, 2024 and apply...more
Summary -
Sponsors of employee benefit plans face heightened plan design and administrative challenges in the wake of President Biden’s surprise termination of the COVID-19 national emergency. This unexpected development,...more
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...more
Summary -
The Departments of Labor, Health and Human Services, and the Treasury have issued guidance on how health plans and insurers may attest to their compliance with the anti-gag rules of the Consolidated...more
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...more