Closing out 2024, the Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule entitled “Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit...more
On September 23, 2024, the U.S. Departments of Labor, the Treasury, and Health and Human Services (collectively, the “Departments”) released final rules (the “Final Rules”) that implement requirements under the Mental Health...more
10/3/2024
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Employer Group Health Plans ,
Final Rules ,
Health and Welfare Plans ,
Health Insurance ,
Healthcare Reform ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
U.S. Treasury
On September 9, 2024, the three federal departments responsible for regulating the health care benefits for more than 175 million Americans with private health insurance issued a final rule (the “Final Rule”) implementing...more
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance and Quality Final Rule, a final rule that updates several...more
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued Ensuring Access to Medicaid Services, a final rule designed to address a range of barriers that Medicaid beneficiaries face in accessing home- and...more
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting,...more
On February 1, 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a final rule revising 42 CFR Part 8, which regulates opioid treatment programs (OTPs). The final rule is the first update to...more
3/7/2024
/ Drug Distribution ,
Final Rules ,
Food & Drug Regulations ,
Health Care Providers ,
Healthcare ,
Life Sciences ,
Mental Health ,
Opioid ,
Patient Access ,
Prescription Drugs ,
SAMHSA ,
Telehealth
On January 18th, the Centers for Medicare & Medicaid Services (CMS) announced a new demonstration model called the Innovation in Behavioral Health (IBH) Model, which is designed to improve outcomes for adults with mental...more
On December 18, 2023, the California Office of Administrative Law approved the emergency regulations promulgated by the Office of Health Care Affordability (OHCA) that set forth the procedural framework for (i) the...more
Under the Biden administration, the Centers for Medicare & Medicaid Services published a health equity framework that drastically changed the playing field for health plans and other risk-bearing entities.
In the wake of...more
On November 15, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule titled Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit...more
12/13/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Drug Pricing ,
Health Insurance ,
Health Plan Sponsors ,
Medicare ,
Medicare Advantage ,
Medicare Part D ,
Out-of-Pocket Expenses ,
Pharmaceutical Industry ,
Prescription Drugs ,
Proposed Rules
On October 7, 2023, California Governor Gavin Newsom signed SB 770 into law, providing for the further development of a framework to establish a unified health care financing system in California....more
On June 8, 2023, the Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), announced a new demonstration model under the authority of Section 1115A of the Social Security Act that...more
Changes are on the horizon for provisions of the Program of All-Inclusive Care for the Elderly (PACE) that haven’t been updated in over a decade.
What exactly is PACE and how will new proposed rule modifications affect PACE...more
The Centers for Medicare & Medicaid Services (CMS) recently issued the Medicare Advantage (MA) and Part D proposed rule for contract year 2024 (the “Proposed Rule”), which represents the Biden administration’s broadest effort...more
The Program The ACO REACH (short for “Accountable Care Organization Realizing Equity, Access, and Community Health”) Model is the new Medicare value-based payment demonstration model for providers launched this year by the...more
On January 25, 2022, the U.S. Department of Labor (“DOL”), Department of Health and Human Services, and Department of the Treasury (collectively, “Departments” or “Regulators”) released their 2022 Annual Report to Congress on...more
2/7/2022
/ Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
Employer Liability Issues ,
Health Insurance ,
Human Resources Professionals ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Substance Abuse ,
U.S. Treasury
In the clearest indication yet of the increased enforcement of the Mental Health Parity and Addiction Equity Act (“MHPAEA”) under the Biden-Harris administration, two settlement agreements filed on August 11 provide that...more
The Departments of Labor, Health and Human Services, and the Treasury jointly released a set of frequently asked questions (“FAQs”) related to recent changes made to the Mental Health Parity and Addiction Equity Act effective...more
6/10/2021
/ Addiction Equity Act ,
Consolidated Appropriations Act (CAA) ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Enforcement Authority ,
Health Insurance ,
Health Plan Sponsors ,
Mental Health ,
Mental Health Parity Rule ,
NQTLs ,
Required Documentation ,
U.S. Treasury
The Mental Health Parity and Addiction Equity Act (“MHPAEA”) and related state parity laws are some of the most complex and sweeping regulations ever imposed on the health insurance and managed care industry. Although MHPAEA...more
As infections of COVID-19 continue to increase throughout the nation, health care policymakers have focused primarily on increasing acute-care hospital bed capacity, promoting (and decreasing the regulatory requirements...more
As communities throughout the nation and world continue to grapple with the 2019 novel coronavirus (“COVID-19”) pandemic, health care providers and plans are struggling not only to maintain standard operations but also to...more
New Jersey’s Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“NJ Law”) creates a statutory framework that attempts to protect consumers from medical bills for out-of-network services...more
Earlier this year, New Jersey Governor Phil Murphy signed into law the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (“Law”), creating a statutory framework attempting to protect...more
Hospitals, health systems, provider groups, and residential and community-based long-term care providers (collectively, “Providers”) should revisit their relationships with Medicare Advantage plans (“MA Plans”) in light of...more