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Reminder: Reporting Requirement for Health Care Costs One Month Away

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

FAQs Provide Guidance on Preventive Care

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

Washington State Poised to Pass Consumer Health Privacy Law

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

Whiplash: The Orderly and Disorderly End to the COVID-19 Declarations

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

Court Invalidates Certain Preventive Care Requirements

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

Unmuzzled: Time to Attest That No Gags Apply

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

Strike Two: Court Again Invalidates No Surprises Procedure

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

Spring Cleaning: Preparing for the COVID Emergency’s End

Summary - The almost three-year-old COVID-19 national emergency and public health emergency declarations (Declarations) are slated to expire May 11, 2023....more

Impact of May 11, 2023 End of COVID-19 Emergency Declarations

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

IRS Finalizes Affordable Care Act Reporting Relief

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

Reviewing the Welfare Plan Rules Under the Consolidated Appropriations Act, 2021

Summary - The Consolidated Appropriations Act, 2021, (CAA) and transparency regulations introduced major changes to health benefit plans. These changes continue to evolve with some requirements just now taking effect....more

Holiday Relief for Reporting Requirements

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

Dispute Resolution Process Is Modified Under the CAA's No Surprise Billing Rules

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

A Watch on Affordability – IRS Adjusts Figure Applicable to Employer Mandate

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

Back and Forth to the Future: HHS Issues Proposed Rules on Nondiscrimination

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

Philadelphia Employers Will Soon Be Required to Provide Commuter Benefits to Their Employees

Summary - On June 9, 2022, the Philadelphia City Council passed an ordinance that would require certain employers to make available to eligible employees a commuter transit benefit program. The bill is currently awaiting...more

Technical Guidance Issued on Transparency in Coverage Regulations

On April 19, 2022, the U.S. Departments of Health and Humans Services, Labor, and Treasury (collectively, the Departments) issued guidance which sets forth two separate safe harbors for group health plans and health insurance...more

Congress Breathes New Life Into Pre-deductible Access to Telehealth Services

The recently enacted Consolidated Appropriations Act, 2022 (CAA 2022) is best known for preventing a government shutdown and providing aid to Ukraine, but its more than 2,600 pages also contain language that revives a...more

The Element of Surprise - The No Surprises Rules Become a Little Less Predictable

In a Memorandum Opinion and Order issued last week, a federal judge in the Eastern District of Texas vacated significant provisions in the regulations under the No Surprises Act....more

More Guidance on Coverage of Over-the-Counter COVID-19 Test Kits

Following up on their earlier guidance the Departments of the Treasury, Labor, and Health and Human Services have issued an additional set of frequently asked questions and answers on the requirement to cover over-the-counter...more

The CAA Prescription Drug Benefit Reporting Requirement

Summary - The Consolidated Appropriations Act, 2021 (CAA) requires group health plans and health insurers to submit information regarding the costs of prescription drug costs and other health care services each year to the...more

The CAA's New Rules for Health Care Provider Directories

Summary - The Consolidated Appropriations Act (CAA) requires each group health plan and health insurer with a network of providers to maintain a database on a public website that lists the name, address, specialty,...more

Provider's Claims for COVID-19 Screening Charges Move Forward

Addressing motions to dismiss, a district court in Texas has found that a provider may proceed with its lawsuit to recover the full amount of its charges for COVID-19 diagnostic testing under the FFCRA and CARES Act from an...more

The CAA's New Identification Card Requirements

Summary - To help individuals better understand the costs they will bear for medical care, the Consolidated Appropriations Act (CAA) requires health plan ID cards to include clear information about deductibles and...more

Understanding the New Continuity of Care Rule

Summary - Under a new rule introduced by the Consolidated Appropriations Act, 2021 (CAA), a health plan or insurer must offer an enrollee the opportunity to elect a transitional period of continued care with a provider...more

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