News & Analysis as of

Cost-Sharing Health Insurance

Ogletree, Deakins, Nash, Smoak & Stewart,...

ACA-Required Coverage of Contraceptive Care Remains Agency Focus

Once again, the U.S. Departments of Labor, Health and Human Services, and the Treasury have issued guidance on the Affordable Care Act’s (ACA) required coverage of contraception without cost sharing, clarifying the permitted...more

Groom Law Group, Chartered

HHS Drops Appeal in Drug Coupon Case

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

Nelson Mullins Riley & Scarborough LLP

Expanded Behavioral Health Access, Enhanced Price Transparency, and the 340B Remedy in the CY 2024 Hospital Outpatient and...

The Centers for Medicare & Medicaid Services (CMS) has announced new measures to enhance access to behavioral health services for Medicare beneficiaries and improve hospital price transparency as part of the final rule for...more

Ballard Spahr LLP

Prescription for Chaos: Copay Accumulator Programs Called Into Question

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Summary - Employers taking advantage of copay accumulator programs now face unexpected administrative complications following a recent federal court decision....more

Goodwin

Federal Court Strikes Down Copay Accumulator Programs

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On September 29, 2023, the U.S. District Court for the District of Columbia vacated a Trump-era rule from 2021 that allowed insurers to exclude drug manufacturer co-pay support coupons and assistance from a patient’s annual...more

Cornerstone Research

5 Questions with Erin Trish: Surprise Billing in Healthcare

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5 Questions is a periodic feature produced by Cornerstone Research, which asks our professionals, senior advisors, or affiliated experts to answer five questions. We interview Professor Erin Trish, of the Schaeffer Center...more

Ballard Spahr LLP

Meet Me at the Corner of No Surprises and …

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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

Sheppard Mullin Richter & Hampton LLP

Navigating the Wild West of the New ACA Preventative Care Ruling

On March 30, Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas issued a decision in Braidwood Management Inc. v. Becerra (“Braidwood”), invalidating the Affordable Care Act’s (“ACA’s”) mandate...more

Dickinson Wright

Federal Court Blocks Enforcement of Some ACA Preventive Health Service Requirements: What Plan Sponsors Should Consider

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In a March 2023 ruling, a Texas federal district court vacated all actions taken by the Departments of Labor (“DOL”), Health and Human Services (“HHS”), and Treasury (collectively, the “Departments”) to implement or enforce...more

Bradley Arant Boult Cummings LLP

Departments Issue Guidance on Preventive Services under the ACA Following the Braidwood Decision

In light of the March 30 Braidwood Mgmt. Inc. v. Becerra decision, the Department of Labor, Department of Health and Human Services, and Department of the Treasury (the “departments”) have issued FAQ guidance on how the...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Federal District Court’s Ruling on Affordable Care Act Preventive Care Eases Employer Burden—at Least for Now

Employers, at least for now, may have some relief from some of the Affordable Care Act (ACA) requirements to cover preventive care services without cost sharing under a nationwide injunction issued March 30, 2023, by a...more

Akerman LLP - HR Defense

Your Employee Benefit Plans May Need a Check Up: Nearing the End of the COVID-19 Public Health Emergency

Where did the time go? Just a brief 1,199 days after it began, the COVID-19 Public Health Emergency (PHE) is coming to an end. The PHE formally ends on May 11, 2023, short of any unexpected developments. And that means the...more

McDermott Will & Emery

Tri-Agencies Address Preventive Services Coverage in the Wake of Braidwood

McDermott Will & Emery on

In response to Braidwood Mgmt. Inc. v. Becerra, a recent case striking down part of the Affordable Care Act (ACA) preventive services mandate, the US Departments of Labor, Health and Human Services, and the Treasury...more

Groom Law Group, Chartered

ACA Preventive Service Requirements Partially Vacated

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

Nelson Mullins Riley & Scarborough LLP

Telehealth Coverage Reinstated for HDHP/HSAs Effective April 1, 2022

The Consolidated Appropriations Act of 2022 (“2022 CAA”), which was recently signed into law, reinstates the exception that allows high deductible health plans (“HDHPs”) to waive all or a portion of participant cost-sharing...more

Manatt, Phelps & Phillips, LLP

[Webinar] No Surprises Act Implementation: Immediate Challenges for Payers and Providers - March 30th, 1:00 pm - 2:00 pm ET

The federal No Surprises Act (NSA), which went into effect January 1, 2022, protects patients from surprise medical bills for emergency services and for when they are treated by out-of-network providers in an in-network...more

Groom Law Group, Chartered

Update! Departments Issue More Guidance Addressing Coverage of Over-the-Counter COVID-19 Tests

On December 2, 2021, President Biden announced new actions to combat COVID-19, given the emergence of the new Omicron variant. As part of his nine-point plan, the President included a directive that “the more than 150...more

Proskauer - Employee Benefits & Executive...

There’s More! Tri-Agencies Provide Clarifying Guidance on Group Health Plan Coverage of Over-the-Counter At-Home COVID-19 Tests

A few short weeks ago we told you in a blog post that, with only four days’ notice, the Departments of Labor, Treasury, and HHS (the Departments) required that, starting January 15, 2022, group health plans cover FDA-approved...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

Federal "No Surprises Act" Is Now the Law

On January 1, 2022, the Biden Administration’s Federal No Surprises Act (NSA) took effect. The NSA provides new protections against unsuspected medical bills. It is intended to combat the negative impact of the rising cost of...more

Ballard Spahr LLP

U.S. Department of Health and Human Services Approves Updates to the List of Preventive Items and Services to be Covered Without...

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Revisions to preventive care and screening guidelines will require health plans and health insurance policies to provide 100 percent coverage for additional services for women, adolescents, children, and infants, following an...more

Venable LLP

Employer Group Health Plans Must Cover Over-the-Counter COVID Tests

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On Monday, the government issued frequently asked questions (FAQs) requiring employer group health plans (Plans) and health insurance issuers to cover certain over-the-counter (OTC) COVID-19 tests at no cost to the...more

Polsinelli

Group Health Plan Coverage Requirements Expanded to Include Non-Prescribed Over-the-Counter COVID-19 Testing

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Effective January 15, 2022, health plans are required to cover the cost of over-the-counter (“OTC”) COVID-19 test kits obtained without a health care provider’s prescription or clinical assessment. This new requirement was...more

Stinson LLP

Agencies Issue Guidance Requiring Coverage for Over-the-Counter COVID-19 Tests

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Beginning January 15, 2022, and through the duration of the public health emergency, insurers and group health plans must cover at-home COVID-19 diagnostic tests available over-the-counter (OTC) without imposing cost-sharing,...more

Proskauer - Employee Benefits & Executive...

You Can Go Home Again: Tri-Agencies Release New Group Health Plan Coverage Requirements for Over-the-Counter At-Home COVID-19...

Looking forward to the weekend? Many employers and plan administrators may also have been . . . up until yesterday, when the government issued new requirements that take effect on Saturday. ...more

Polsinelli

New Federal Surprise Billing Prohibition and Its Implication on State Laws

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On July 1, 2021, the Biden-Harris Administration issued “Requirements Related to Surprise Billing; Part 1,” an interim final rule (IRM) that will restrict health care providers and facilities from sticking patients with...more

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