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
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
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 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 -
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
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 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
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 -
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
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
The Employer Shared Responsibility Provisions (commonly known as the “employer mandate”) under the Affordable Care Act (ACA) require applicable large employers to pay an assessment under the Internal Revenue Code if they fail...more
Summary -
The Department of Health and Human Services (HHS) has issued proposed regulations under the nondiscrimination provisions of Section 1557 of the Affordable Care Act (ACA). The proposed rules restore and augment a...more
Each year since employers have been required to prepare reports under the employer and individual mandates of the Affordable Care Act, the IRS has extended the deadline for distributing the forms to employees. It appeared as...more
Summary -
Throughout 2020 and 2021, employers sponsoring health and welfare plans have needed to respond to a myriad of legislative and regulatory changes arising from the COVID-19 pandemic and new health legislation. To...more
Summary -
A set of Frequently Answered Questions addresses several issues of vital interest to employers in assessing the connection between COVID-19 vaccinations and their health plans....more
In a 7-2 decision, the Supreme Court rebuffed a challenge to the constitutionality of the Affordable Care Act, finding that the plaintiffs who challenged the ACA lacked standing to bring the lawsuit....more
Summary -
Federal agencies will enforce Section 1557 of the Affordable Care Act to prohibit discrimination based on sexual orientation or gender identity. The announcement reverses an effort under the previous...more
The U.S. District Court for the Eastern District of New York blocked federal rules seeking to remove nondiscrimination protections for health care patients. The blocked rules would have removed protections against...more
8/21/2020
/ Affordable Care Act ,
Bostock v Clayton County Georgia ,
Civil Rights Act ,
Department of Health and Human Services (HHS) ,
Gender Identity ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
New Rules ,
Non-Discrimination Rules ,
Sexual Orientation Discrimination ,
Sexual Stereotyping ,
Title IX ,
Title VII
The U.S. Court of Appeals for the District of Columbia Circuit upheld the final regulations issued by the Trump administration that increased the availability of short term, limited duration insurance (STLDI). ...more
In Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, the Supreme Court this week upheld regulations issued by the U.S. Departments of Treasury, Labor, and Health and Human Services (the Departments) that...more
7/13/2020
/ Administrative Authority ,
Administrative Procedure Act ,
Affordable Care Act ,
Appeals ,
Contraceptive Coverage Mandate ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Employer Mandates ,
Employer Rights ,
HRSA ,
Injunctive Relief ,
Little Sisters of the Poor Saints Peter and Paul Home v Pennsylvania ,
Religious Exemption ,
Religious Freedom Restoration Act (RFRA) ,
Reversal ,
SCOTUS ,
Trump v Pennsylvania ,
U.S. Treasury
The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has finalized rules that narrow and eliminate various nondiscrimination requirements under Section 1557 of the...more
The U.S. Supreme Court has determined that the federal government must pay over $12 billion to certain health insurers that participated in health insurance exchanges in the first three years that those exchanges were in...more
5/5/2020
/ Affordable Care Act ,
Appropriations Bill ,
Court of Federal Claims ,
Damages ,
Government Payments ,
Health Insurance ,
Maine Community Health Options v. United States ,
Moda Health Plan Inc. v. United States ,
Reimbursements ,
Remand ,
Repeal ,
Reversal ,
Risk Corridors Statute ,
SCOTUS ,
Tucker Act
Across the United States, employers are carefully considering how the COVID-19 pandemic is affecting their business. As we await further guidance and pronouncements from federal, state, and local officials, some employers are...more
3/18/2020
/ Affordable Care Act ,
COBRA ,
Coronavirus/COVID-19 ,
Crisis Management ,
DFSA ,
Emergency Management Plans ,
Furloughs ,
Health and Safety ,
Health and Welfare Plans ,
Health Insurance ,
Infectious Diseases ,
Layoffs ,
Public Health ,
Retirement Plan ,
Unemployment Benefits
Below is a summary of those key provisions. I. SECURE Act The Setting Every Community Up for Retirement Enhancement Act of 2019 (the SECURE Act, H.R. 1994) is arguably the most significant and comprehensive retirement saving...more
12/23/2019
/ 401k ,
Affordable Care Act ,
Compensation & Benefits ,
Corporate Counsel ,
Employee Benefits ,
Health Insurance Tax ,
Healthcare Reform ,
Individual Retirement Account (IRA) ,
Medical Leave ,
Multiemployer Plan ,
New Legislation ,
Paid Family Leave Law ,
PCORI ,
Required Minimum Distributions ,
Retirement ,
Retirement Plan ,
Safe Harbors ,
SECURE Act ,
Tax Cuts and Jobs Act ,
Tax Planning ,
Tax Rates ,
Tax Reform ,
UBIT