The Mental Health Parity and Addiction Equity Act and its implementing regulations and guidance (MHPAEA) prohibit health insurance policies and group health plans that cover mental health and substance use disorder (MH/SUD)...more
9/19/2024
/ Compliance ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary ,
Final Rules ,
Health Plan Sponsors ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Substance Abuse ,
U.S. Treasury
There are new regulations requiring employers who offer hospital indemnity or other fixed indemnity insurance benefits for plan years starting on or after January 1, 2025, to provide specific notice of the benefit to all...more
Individual Coverage Health Reimbursement Arrangements (ICHRAs) have continued to grow in popularity since their inception in 2019 (see our article here summarizing the 2019 rule establishing ICHRAs). While initially it seemed...more
6/19/2024
/ COBRA ,
Employee Benefits ,
Health Insurance Portability and Accountability Act (HIPAA) ,
ICHRA ,
IRS ,
Medicare ,
Payment Systems ,
PCORI ,
Popular ,
Reporting Requirements ,
Small Business ,
Vendors
The Consolidated Appropriations Act, 2021 (CAA) added a requirement for health plans to document their compliance with nonquantitative treatment limitations (NQTLs) under the Mental Health Parity and Addiction Equity Act...more
9/21/2023
/ Consolidated Appropriations Act (CAA) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Mental Health Parity Rule ,
MHPAEA ,
New Guidance ,
NQTLs ,
Opioid ,
Proposed Rules ,
Substance Abuse ,
U.S. Treasury
On March 17, 2023, the Internal Revenue Service (IRS) released updated guidance on whether certain costs related to substance abuse programs, exercise programs, wellness and general health qualify as medical expenses under...more
The Consolidated Appropriations Act, 2021 requires group health plans to report specific air ambulance claim data, as summarized in our prior articles available here and here. As noted in our prior articles, proposed rules...more
Under the Consolidated Appropriations Act, 2021 (CAA), group health plans and health insurance issuers are required to annually attest that they are in compliance with the CAA’s gag clause prohibition. On a high level, the...more
On January 30th, President Biden announced his intention to end both the COVID-19 national emergency and the COVID-19 public health emergency (together, the “Emergency Declarations”) effective May 11, 2023. The Emergency...more
The Consolidated Appropriations Act of 2023 (2023 CAA) further extends the HSA safe harbor allowing high deductible health plans (HDHPs) to offer first dollar coverage of telehealth services without ruining HDHP members’...more
On December 23, 2022, the Departments of Labor, Health and Human Services and the Treasury (collectively, the “Departments”) provided welcome relief in the form of an FAQ regarding the Prescription Drug Data Collection (RxDC)...more
This year, Foley’s Health Benefits Practice has released multiple alerts on several of the new group health plan requirements set forth by the Consolidated Appropriations Act of 2021 (CAA) and the Transparency in Coverage...more
Group health plans must comply with several new requirements set forth by the Consolidated Appropriations Act of 2021 (CAA) and the Transparency in Coverage regulations (TiC Regulations) under the Affordable Care Act (ACA). ...more
10/27/2022
/ Consolidated Appropriations Act (CAA) ,
Continuity of Care ,
Cost-Sharing ,
Disclosure ,
Gag Clauses ,
Health Care Providers ,
Mental Health Parity Rule ,
No Surprises Act (NSA) ,
Price Transparency ,
Reporting Requirements ,
Third-Party Service Provider
Air ambulance services often result in large, unanticipated medical bills for patients. A study by the Government Accountability Office found that in 2017, 69% of air ambulance transports provided to individuals covered by...more
10/19/2022
/ Deadlines ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
GAO ,
HCPCS ,
Health Insurance ,
Health Plan Sponsors ,
No Surprises Act (NSA) ,
Proposed Rules ,
Third-Party ,
U.S. Treasury
Not surprisingly, leading up to and in the wake of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, our employee benefits team has been spending a lot of time helping our clients wade through...more
7/20/2022
/ Abortion ,
COBRA ,
Coronavirus/COVID-19 ,
Dobbs v. Jackson Women’s Health Organization ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Health Insurance Portability and Accountability Act (HIPAA) ,
IRS ,
Medical Reimbursement ,
Mental Health Parity Rule ,
MHPAEA ,
Pharmacy Benefit Manager (PBM) ,
SCOTUS
Enforcement of one of the Transparency in Coverage Final Rules (“TiC Rules”) begins on July 1, 2022. The rule requires plans and issuers to make machine-readable files publicly available that will disclose in-network rates...more
Over the last two years, behavioral health (BH) has been one of the biggest growth areas in the health care ecosystem, fueled by the Public Health Emergency (PHE) but in many ways an ignored, overlooked, understaffed, and...more
4/1/2022
/ CMMI ,
Consolidated Appropriations Act (CAA) ,
DEA ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Health Care Providers ,
Investors ,
Medicaid ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Out of Network Provider ,
Public Health Emergency ,
Reimbursements ,
Substance Abuse ,
Surprise Medical Bills
The Consolidated Appropriations Act, 2022, signed into law on March 15, 2022, extended relief first made available at the start of the pandemic which allowed first dollar coverage for telehealth services under a high...more
On January 25, 2022, the U.S. Departments of Labor (“DOL”), Treasury, and Health and Human Services (the “Departments”) provided a report (the “Report”) on Mental Health Parity and Addiction Equity Act (“MHPAEA”) compliance...more
The Consolidated Appropriations Act, 2021 (CAA) generally requires group health plan sponsors to request and review fee information from their plan service providers who provide brokerage services or consulting. This fee...more
The Consolidated Appropriations Act, 2021, Public Law 116-260 (CAA) set forth new compensation disclosure requirements that apply to service providers who provide “brokerage services” or “consulting” to group health plans...more
1/14/2022
/ Compensation ,
Consolidated Appropriations Act (CAA) ,
Department of Labor (DOL) ,
Disclosure Requirements ,
Employee Assistance Programs ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Flexible Savings Accounts (FSAs) ,
HRA ,
Pharmacy Benefit Manager (PBM) ,
Third-Party
Under the Consolidated Appropriations Act, 2021 (the “CAA”), group health plans and health insurance issuers are required to submit certain information related to prescription drug and other health care spending to the...more
Under the Consolidated Appropriations Act, 2021 (the “CAA”), group health plans and health insurance issuers are required to submit certain information related to prescription drug and other health care spending to the...more
The effective date is fast approaching for certain provisions of the Consolidated Appropriations Act of 2021 (“CAA”) and related regulations, and the Transparency in Coverage Rule. You can access previous articles written...more
12/1/2021
/ Affordable Care Act ,
Compliance ,
Consolidated Appropriations Act (CAA) ,
Continuity of Care ,
Disclosure Requirements ,
Drug Pricing ,
Employer Group Health Plans ,
Explanation of Benefits (EOBs) ,
Mental Health Parity Rule ,
Price Comparisons ,
Price Transparency ,
Surprise Medical Bills ,
TPAs ,
Transparency ,
Vendors
...The Consolidated Appropriations Act, 2021, Public Law 116-260 (CAA) sets forth new compensation disclosure requirements that apply to brokers and consultants with respect to both fully-insured and self-insured group health...more
Recent court trends suggest that preemption under the Employee Retirement Income Security Act (ERISA) may not apply to certain state laws that regulate pharmacy benefit managers (PBMs), including state laws governing Maximum...more
6/16/2021
/ Drug Pricing ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Preemption ,
Prescription Drug Coverage ,
Prescription Drugs ,
Rutledge v Pharmaceutical Care Management Association ,
SCOTUS