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 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
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 -
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
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 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
Summary -
The almost three-year-old COVID-19 national emergency and public health emergency declarations (Declarations) are slated to expire May 11, 2023....more
On January 30, 2023, the Biden Administration said that it will end COVID-19 emergency declarations on May 11, 2023. The federal government has been paying for COVID-19 vaccines, some tests, and certain treatments under the...more
Since the inception of the annual reporting requirements under the Affordable Care Act for Forms 1094 and 1095, the IRS has been annually extending the deadline for employers to distribute those reports to individuals. In...more
With little time to spare before the provisions expired, Congress has extended, and President Biden is set to sign into law, an important safe harbor that allows plan sponsors to continue offering reduced-cost telehealth...more
In a new set of Frequently Asked Questions, the U.S. Departments of Labor, Health and Human Services, and the Treasury provide significant relief to health plan sponsors and insurers seeking to report on expenditures for...more
Summary -
The Departments of Labor, Treasury, and Health & Human Services have finalized regulations regarding the dispute resolution process implemented under the No Surprise Billing Rules in the Consolidated...more