News & Analysis as of

Health Insurance New Guidance

Manatt, Phelps & Phillips, LLP

CMS Releases Guidance to Promote Continuity of Coverage for Individuals Receiving HCBS

On August 19, the Centers for Medicare & Medicaid Services (CMS) released a Center for Medicaid and CHIP Services (CMCS) Informational Bulletin (CIB) and an accompanying slide deck reminding states of their obligation to...more

Manatt, Phelps & Phillips, LLP

New Guidance on Family Planning in Medicaid: Takeaways for States, Plans, and Providers

For states, managed care organizations, and providers—who all play a vital role in ensuring access to family planning services and supplies for the nearly 20 million women ages 18-44 enrolled in Medicaid1—the CIB reiterates...more

Manatt, Phelps & Phillips, LLP

CMS Announces Part D Premium Parameters, New Policy to Stabilize Standalone Part D Premiums

The Centers for Medicare & Medicaid Services (CMS) released the Part D national average bid amount and Part D base beneficiary premiums for 2025. These figures set the premium costs and government subsidies for Medicare...more

Manatt, Phelps & Phillips, LLP

CMS Releases Technical Guidance to States on Complying with Medicaid Access Final Rule

On July 12, CMS released a companion guide to the Ensuring Access to Medicaid Services final rule (the “Access Final Rule”). This technical guidance—which focuses on the provisions regarding fee-for-service (FFS) payment...more

Bass, Berry & Sims PLC

Caution! Contents Hot: Key Benefits Issues to Watch During the Remainder of 2024

Bass, Berry & Sims PLC on

While the sweltering roil of temporary regulatory changes related to the COVID-19 pandemic may have cooled and the initial burst of SECURE 2.0 steam begins to dissipate, sponsors of employee benefit plans should keep their...more

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

McDermott Will & Emery

CMS Releases Guidance on Coverage Criteria, Use of AI and More

McDermott Will & Emery on

On February 6, 2024, the US Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) related to Medicare Advantage (MA) coverage criteria and utilization management (UM) requirements....more

Bricker Graydon LLP

Departments Roll Back Enforcement Discretion in New Guidance on Transparency in Coverage Rules.

Bricker Graydon LLP on

Well, it was good while it lasted. On September 27th, the Departments issued new FAQs regarding implementation of provisions of The Transparency in Coverage Final Rules (TiC Final Rules). ...more

Manatt, Phelps & Phillips, LLP

Access to Care for Justice-Involved Pregnant People With a Substance Use Disorder

There is a critical need to increase access to evidence-based care for justice-involved pregnant people with a substance use disorder (SUD)—and connect them to continued coverage and care upon release—according to national...more

Manatt, Phelps & Phillips, LLP

[Webinar] Mental Health Parity Update: Key Takeaways From the Newest Regulatory Guidance and Litigation Trends - September 19th,...

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans to provide mental health benefits, including coverage for substance use disorders (SUDs), that are in “parity” with medical and surgical...more

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

No Surprises Act Guidance on Out-of-Pocket Maximums and Facility Fees

Employers have some new clarity on the No Surprises Act rules on out-of-network providers and charges under new guidance from the U.S. Department of Labor, U.S. Department of the Treasury, and the U.S. Department of Health...more

Ballard Spahr LLP

COVID-19 Coverage Without a Deductible Ends After 2024

Ballard Spahr LLP on

The Internal Revenue Service (IRS) has issued new guidance, Notice 2023-37, which states that for plan years ending after December 31, 2024, HSA-compatible high-deductible health plans (HDHPs) will no longer be permitted to...more

Verrill

Gag Clauses – New Guidance and Litigation Will Inform Compliance

Verrill on

Certain provisions of the Transparency in Coverage Final Regulations and the Consolidated Appropriation Act, 2021 (“CAA”) require group health plans and/or their vendors to report information to federal agencies. On December...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

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

Ballard Spahr LLP

FAQs Provide Guidance on Preventive Care

Ballard Spahr LLP on

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

Manatt, Phelps & Phillips, LLP

New AAP Childhood Obesity Clinical Practice Guidelines Have Implications for Medicaid

Background - In January 2023, the American Academy of Pediatrics (AAP) released new clinical practice guidelines on the evaluation and treatment of children with obesity. The new guidance, AAP’s first such update in 15...more

Ballard Spahr LLP

Court Invalidates Certain Preventive Care Requirements

Ballard Spahr LLP on

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

Robinson & Cole LLP

Health Law Diagnosis - CMS Issues Guidance for Providers on Waivers, Flexibilities and End of COVID-19 Public Health Emergency

Robinson & Cole LLP on

The Centers for Medicare & Medicaid Services (CMS) recently issued a Fact Sheet (Fact Sheet) providing guidance on the impact of the end of the federal COVID-19 Public Health Emergency (PHE) on certain regulatory waivers,...more

Robinson+Cole Health Law Diagnosis

CMS Issues Guidance for Providers on Waivers, Flexibilities and End of COVID-19 Public Health Emergency

The Centers for Medicare & Medicaid Services (CMS) recently issued a Fact Sheet (Fact Sheet) providing guidance on the impact of the end of the federal COVID-19 Public Health Emergency (PHE) on certain regulatory waivers,...more

Ballard Spahr LLP

Unmuzzled: Time to Attest That No Gags Apply

Ballard Spahr LLP on

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

Husch Blackwell LLP

New Federal Guidance on Employer-Sponsored Group Health Plans and Required Action Steps for 2023

Husch Blackwell LLP on

The Consolidated Appropriations Act, 2021 (CAA) prohibits employer-sponsored group health plans from entering into agreements that contain so-called “gag clauses.” This prohibition generally restricts group health plans from...more

Nelson Mullins Riley & Scarborough LLP

CMS Releases New REH Conversion Guidance

The Centers for Medicare and Medicaid Services (“CMS”) recently released new guidance about the process for converting to a Rural Emergency Hospital (“REH”) – a new Medicaid provider type effective Jan. 1, 2023. REHs are...more

Sheppard Mullin Richter & Hampton LLP

CMS Issues Interprofessional Consultation Guidance

Introduction: Defining Interprofessional Consultation - In a January 5, 2023, letter to state health officials, the Centers for Medicare & Medicaid Services (“CMS”) clarified a Medicaid and Children’s Health Insurance...more

Kramer Levin Naftalis & Frankel LLP

NAIC Group Updates Financial Analysis Tools

A National Association of Insurance Commissioners (NAIC) working group adopted changes to the NAIC’s Financial Analysis Handbook (Handbook) capturing a number of current topics affecting insurers. Insurers should consider the...more

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