Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more
Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more
Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more
On January 22, the Departments of Labor, Treasury, and Health and Human Services (“Tri-Agencies”) issued a set of Frequently Asked Questions (“ACA FAQs Part 64”) clarifying the contraceptive-related services that plans and...more
On January 16, 2023, the Department of Health and Human Services (“HHS”) dropped its appeal of the U.S. District Court for the District of Columbia’s September 29, 2023 decision that vacated a portion of the 2021 Notice of...more
On December 19, 2023, the Department of Labor (“DOL”) issued a proposed rule rescinding a Trump Administration rule that expanded the availability of association health plans (“AHPs”) (the “Proposed Rule”)....more
On September 29, 2023, the U.S. District Court for the District of Columbia vacated the 2021 Notice of Benefit and Payment Parameters (“2021 NBPP”) amendments to Affordable Care Act regulations. The amendments permitted (but...more
On August 15, 2023, the Tenth Circuit issued its much-anticipated decision in PCMA v. Mulready, rejecting Oklahoma’s position that its pharmacy network requirements were not preempted by ERISA. Mulready has been closely...more
On July 25, 2023, the Departments of Health and Human Services, Labor and Treasury (“Tri-Agencies”) issued sweeping new guidance on the Mental Health Parity and Addiction Equity Act (“MHPAEA”), including a Proposed Rule, a...more
State legislatures over the past five years have focused heavily on the role of pharmacy benefit managers (“PBMs”) in the context of health care benefits. While initial efforts were focused largely on PBM services offered to...more
On July 7, the Departments of Labor, Treasury, and Health and Human Services (the “Tri-Agencies”) published a long-anticipated proposed rule (“Proposed Rule”) that...more
CMS published the Calendar Year (“CY”) 2024 Medicare Advantage (“MA”) Capitation Rates and Part C and Part D Payment Policies (“Rate Announcement“) on March 31 and, five days later, issued the MA and Part D final rule for...more
On March 30, 2023, the District Court for the Northern District of Texas issued an opinion and order in Braidwood Mgmt. Inc. v. Becerra that vacates the implementation and enforcement of certain preventive service provisions...more
4/3/2023
/ Affordable Care Act ,
Constitutional Challenges ,
Cost-Sharing ,
Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Healthcare ,
Non-Grandfathered Health Plans ,
Preventive Health Care ,
Religious Freedom Restoration Act (RFRA) ,
Vacated
More than four years after it was proposed, on February 1, 2023 the Centers for Medicare & Medicaid Services (CMS) published the long-awaited risk adjustment data validation (RADV) Final Rule (Final Rule) that will affect...more
2/24/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Extrapolation ,
Fee-for-Service ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Risk Adjustment Formula
Last week the Senate passed the Continuing Appropriations Act, 2023 (“CAA23”). The House of Representatives will likely consider the measure today, and President Biden is expected to sign the bipartisan measure into law...more
12/26/2022
/ Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Health Savings Accounts ,
Healthcare ,
Healthcare Reform ,
HSA ,
Medicaid ,
Medicare ,
Medicare Secondary Payer Act ,
Mental Health Parity Rule ,
Pending Legislation ,
Regulatory Agenda ,
Telehealth
On August 4, 2022, the Biden Administration published its long-anticipated proposed rulemaking on Affordable Care Act (“ACA”) Section 1557’s nondiscrimination in health programs and activities requirements (“Proposed Rule”)....more
The Paul Wellstone and Peter Domenici Mental Health Parity and Addiction Equity Act of 2008 (“MHPAEA”) has increasingly been the focus of government enforcement activity and private plaintiff litigation. In its 2022 Report to...more
The ongoing implementation of the No Surprises Act’s (“NSA”) prohibition on surprise balance billing, and the related independent dispute resolution (“IDR”) process between payers and providers became much less certain after...more
On July 1, 2021, the Office of Personnel Management, Department of the Treasury, Department of Health and Human Services (“HHS”), and Department of Labor (“DOL”) (collectively, the “Departments”), released the interim final...more
The Mental Health Parity and Addiction Equity Act of 2008’s (“MHPAEA”) provisions of the Consolidated Appropriations Act, 2021 (the “CAA”) became effective February 10, 2021 and added a requirement for group health plans and...more
The Consolidated Appropriations Act, 2021 (the “CAA”) that was signed into law on December 27, 2020, amends the Employee Retirement Income Security Act of 1974 (“ERISA”), the Public Health Service Act and the Internal Revenue...more
This webinar will include a discussion on the various provisions of the new surprise billing law, how it interacts with current law, expected guidance from the Biden Administration, and implications for health insurance...more
1/6/2021
/ Biden Administration ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare Reform ,
Hospitals ,
New Legislation ,
Out of Network Provider ,
Physicians ,
Surprise Medical Bills ,
Webinars
In the recently-decided Rutledge v. Pharmaceutical Care Management Association (“PCMA”), the Supreme Court found 8–0 (Justice Barrett did not take part) that ERISA did not preempt an Arkansas state law that established...more
1/5/2021
/ Corporate Counsel ,
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
On December 21, the House and Senate passed a $2.3 trillion omnibus appropriations and COVID-19 relief package, H.R. 133, the Consolidated Appropriations Act, 2021 (the “Act”). President Trump signed the Act into law on...more
The dust has settled and the 2020 election has concluded with former Vice President Biden poised to become president. At the same time, Democratic control of the House of Representatives has narrowed to the smallest margin...more