News & Analysis as of

Qualified Health Plans

Benesch

Dialysis & Nephrology Digest - June 2024

Benesch on

KCP supports House bill to restore original intent of Medicare Secondary Payer Act - Kidney Care Partners (KCP) commends the 36 co-sponsors of the bill before the House, who come from both sides of the aisle and represent...more

K&L Gates LLP

CMS Finalizes New Interoperability Rule Promoting Improvements to Prior Authorization Processes

K&L Gates LLP on

On 17 January 2024, the Centers for Medicare & Medicaid Services (CMS) released a final rule outlining new interoperability and prior authorization requirements for certain payors (Final Rule). With the adoption of the Final...more

McDermott Will & Emery

CMS Interoperability and Prior Authorization Rule Significantly Impacts Payers’ Approval and Denial Practices

McDermott Will & Emery on

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization final rule (Final Rule) (fact sheet, CMS’ interoperability website), which aims to improve prior...more

Manatt, Phelps & Phillips, LLP

FY 2025 Executive Budget Women’s Health Highlights

Earlier this week, Governor Kathy Hochul released her Executive Budget proposal totaling $233 billion for State Fiscal Year 2025. The budget proposes several initiatives targeted at improving access to, quality of, and...more

Arnall Golden Gregory LLP

Mental Health Crisis: Unmasking Ghost Networks

As the United States continues to grapple with a growing mental health crisis, millions are finding it increasingly difficult to access and afford mental health treatment. Recent investigations conducted by the New York...more

Warner Norcross + Judd

IRS Increases Benefit Plan Limits for 2024

Warner Norcross + Judd on

The IRS has announced increased annual limits for retirement and other benefit plans for 2024. While the increases for 2024 are smaller than we’ve seen in prior years, they still may have a significant impact on plans and...more

Sheppard Mullin Richter & Hampton LLP

PBM Practices Receive Increased Federal Scrutiny

Though many recent reforms regarding prescription drug affordability have been focused on manufacturers and health plans, pharmacy benefit managers (“PBMs”) are also the focus of increased attention from federal policymakers...more

K&L Gates LLP

CMS Proposed Rule Seeks to Provide Transparency and Efficiency in Preauthorization Process

K&L Gates LLP on

INTRODUCTION - On 13 December 2022, the Centers for Medicare and Medicaid Services (CMS) published CMS-0057-P (the Rule),1 a proposed rule that, if adopted, will place new requirements on a number of entities, including...more

Groom Law Group, Chartered

CMS Proposed Rule Would Leverage Technology and Interoperability to Improve Prior Authorization

On Tuesday, December 13, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“New Proposed Rule”) to improve the prior authorization process and advance interoperability for Medicare Advantage...more

King & Spalding

CMS Proposes Rule to Require Certain Health Plans to Electronically Share Data with Providers Regarding Prior Authorization...

King & Spalding on

On December 13, 2022, CMS is set to publish in the Federal Register a proposed rule (Proposed Rule) requiring certain Medicare, Medicaid, Children’s Health Insurance Program, and Qualified Health Plan fee-for-service and...more

Seyfarth Shaw LLP

[Quiet] Extension of IRS Notice 2022-41 to Include Calendar Year Cafeteria Plans

Seyfarth Shaw LLP on

Seyfarth Synopsis: IRS quietly extends relief for the “family glitch” to calendar year cafeteria plans in unannounced revisions to Notice 2022-41. ...more

Seyfarth Shaw LLP

Final Rules Fix Family Glitch

Seyfarth Shaw LLP on

Seyfarth Synopsis: Recently, on October 11, 2022, the Internal Revenue Service (IRS) issued final regulations which finalized changes to affordability of employer coverage for the family members of employees under Internal...more

Manatt, Phelps & Phillips, LLP

CMS Revives Standardized Plans and Federal Network Adequacy Review

The Centers for Medicare & Medicaid Services (CMS) released the final 2023 Notice of Benefit and Payment Parameters (NBPP), the annual rule outlining key policies for the individual and group health insurance markets for plan...more

Nossaman LLP

Understanding the HHS 2023 Proposed Rule

Nossaman LLP on

The Department of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters for the 2023 Proposed Rule on Wednesday, January 5th 2022. ...more

King & Spalding

HHS Releases Notice of Benefit and Payment Parameters 2023 Proposed Rule

King & Spalding on

On December 28, 2021, HHS released a proposed rule governing plans issued in the Patient Protection and Affordable Care Act (ACA) marketplaces beginning with the 2023 plan year (the Proposed Rule). Among other changes to the...more

Sheppard Mullin Richter & Hampton LLP

Back to the Future: 2023 Payment Rule Would Revert Nondiscrimination and Guaranteed Availability Provisions to Pre-Trump Forms,...

Today HHS published the Notice of Benefit and Payment Parameters for 2023 proposed rule in the Federal Register. The annual rulemaking details changes to qualified health plans (“QHPs”), QHP issuers, and the ACA’s exchanges...more

Manatt, Phelps & Phillips, LLP

Interoperability and Transparency Rules Usher in a New Era of Health Plan Data Obligations

After a six-month delay due to the COVID-19 pandemic, the first provisions of the interoperability rule issued by the Centers for Medicare & Medicaid Services (CMS) took effect on July 1. The new requirements are the first of...more

Alston & Bird

Alston & Bird Health Care Week in Review - July 2021 #1

Alston & Bird on

Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in healthcare regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and...more

Payne & Fears

Consumer Class Action Against Sutter Health Allowed to Proceed

Payne & Fears on

A recent case in the Northern District of California presents a reminder that hospital systems need to consider antitrust issues when negotiating multi-hospital contracts with health plans. Unfortunately, even when hospitals...more

Jackson Lewis P.C.

American Rescue Plan Act Extensions, Changes To Select Tax Credit, Compensation Deduction Provisions

Jackson Lewis P.C. on

The American Rescue Plan Act of 2021 expands upon some popular tax credit provisions and makes other changes to a key tax provision regarding compensation deduction limitations. These changes are summarized below...more

King & Spalding

Implementation of Final Rule Excluding PBM Rebates from Discount Safe Harbor Delayed Until 2023

King & Spalding on

Pharmaceutical Care Management Association (“PCMA”) lawsuit results in delayed implementation of Final Rule while Biden Administration review is ongoing - Pursuant to a Court Order, implementation of the U.S. Dept. Health...more

Bradley Arant Boult Cummings LLP

Rule Providing Relief for Grandfathered Health Plans Finalized

The Departments of Labor (DOL) and Health and Human Services (HHS) and the Treasury have finalized a rule for grandfathered group health plans under the Affordable Care Act (ACA) without making any substantive changes from...more

Snell & Wilmer

IRS Issues Revised Guidance on Employee Retention Credits and Qualified Health Plan Expenses, Offering Relief for Employers that...

Snell & Wilmer on

The Coronavirus Aid, Relief and Economic Security Act ("CARES Act") provides for an employee retention credit (“ERC”) designed to encourage employers to retain workers during the COVID-19 crisis. The Internal Revenue Service...more

Littler

IRS Reverses Course on Employee Retention Credit for Qualified Health Plan Expenses

Littler on

The IRS has changed its position and will allow employers to receive a tax credit for paying health care plan premiums for employees on furlough....more

Ballard Spahr LLP

CMS Encourages Flexibility in Utilization Management and Prior Authorization Within Limits

Ballard Spahr LLP on

The Centers for Medicare & Medicaid Services (CMS) issued FAQ guidance encouraging health insurers to relax their utilization management and prior authorization requirements in view of the COVID-19 pandemic while at the same...more

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