Section 1557 of the Affordable Care Act mandates nondiscrimination in health care programs managed or funded by the Department of Health and Human Services (HHS), with upcoming deadlines for compliance set for May and July 2025. However, uncertainties remain regarding
Health Care Reform Dashboard
Charting Developments with the Affordable Care Act and Beyond
HHS Proposes Significant Updates to HIPAA Security Rule
The U.S. Department of Health and Human Services (HHS) has proposed changes to its Health Insurance Portability and Accountability Act (HIPAA) Security Rule designed to enhance the cybersecurity of health care providers, health plans, and related entities.
The Upshot
- If
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Surprise, Surprise! No Surprise Billing Regulations Upheld
Summary
The Fifth Circuit Court of Appeals recently upheld regulations defining the qualifying payment amount (QPA). The QPA is a key factor in determining how much individuals and health plans must pay out-of-network providers in certain situations, where the individual…
IRS Guidance Expands List of Preventive Care Benefits Under HDHPs
Practical Pointers for Compliance With New MHPAEA Regulations
Summary
The Departments of the Treasury, Labor, and Health and Human Services have published final regulations under the Mental Health Parity and Addiction Equity Act that prohibit group health plans and health insurers from imposing nonquantitative treatment limitations that place…
Tobacco Surcharge Lawsuits Lighting Up Common Wellness Program Designs
A new and unprecedented wave of class action complaints is targeting a common feature of many employer-sponsored benefit plans: tobacco-user surcharges. These surcharges are often part of a wellness program that charges higher medical plan premiums to participants who fail…
DOL Updates Cybersecurity Guidance to Confirm It Applies to All Employee Benefit Plans
Summary
The U.S. Department of Labor (DOL) updated its 2021 cybersecurity guidance to clarify that it applies to all employee benefit plans. The DOL guidance confirms that plan fiduciaries, including health and welfare plan fiduciaries, have an obligation to evaluate the cybersecurity…
Health Plan Compliance Deadlines Draw Near
Regulations under Section 1557 of the Affordable Care Act and HIPAA will require health plans and health care providers to take action in the coming months to meet new requirements. Health plan sponsors and providers that have not started to…
Fifth Circuit Affirms Invalidity of No Surprises Regulations
Summary
The Fifth Circuit Court of Appeals has affirmed the invalidity of regulations governing the independent review process under the No Surprise Billing Rules.
The Upshot
- Out-of-network health care providers challenged the regulations as going beyond the statute and tilting
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Courts Invalidate ACA Regulations Following Demise of Chevron Deference
Summary
Following the U.S. Supreme Court’s decision to overturn its Chevron decision three district courts have struck down provisions in nondiscrimination regulations under the Affordable Care Act that prohibit discrimination based on gender identity. in what constitutes unlawful discrimination.
The…