Health & Welfare

Agencies Issue Proposed Rules Regarding Health Care Transparency

Last June, in Executive Order 13877, President Trump directed HHS, Treasury, and Labor (collectively, the “Agencies”) to solicit comments on how providers, insurers, and group health plans could be required to disclose information about expected out-of-pocket costs before a patient receives care.  In response, the Agencies issued proposed regulations, with respect to which the comment period ...

Increased Penalties for HIPAA Noncompliance

HHS has issued final regulations containing inflation adjustments to the civil penalties for violations of HIPAA's "administrative simplification" rules.

IRS Issues Guidance to Clarify Health Reimbursement Arrangement Rules

The IRS has issued proposed regulations to clarify the application of the ACA's employer shared responsibility provisions under Section 4980H of the Internal Revenue Code (the "Code") and certain nondiscrimination rules for self-funded plans under Code Section 105(h) to Individual Coverage Health Reimbursement Arrangements ("ICHRAs"). Background. The ACA's employer shared responsibility ...

Agencies Issue Final FAQs on Mental Health Parity Implementation

HHS, DOL and IRS have issued final FAQs on the implementation of the requirements of the Mental Health Parity and Addiction Equity Act ("MHPAEA"). The MHPAEA requires that the financial requirements (e.g., coinsurance and copays) and treatment limitations (e.g., visit limits) imposed on mental health or substance use disorder ("MH/SUD") benefits cannot be more restrictive than the predominant ...

Agencies Issue Guidance on Impact of Drug Manufacturer Coupons on ACA's Out-Of-Pocket Limits

DOL, IRS and HHS (collectively, the "Agencies") have issued a FAQ to address whether drug manufacturers' coupons for name brand prescription drugs should be counted toward the annual cost-sharing limits under the Affordable Care Act ("ACA"), including situations where there is no medically appropriate generic drug available.

IRS Expands List of Preventive Care Benefits

IRS has issued Notice 2019-45 which expands the list of "preventive care benefits" permitted to be provided by a high deductible health plan ("HDHP") when determining if an individual is eligible to make tax-exempt contributions to a health savings account ("HSA"). In general, an individual is eligible to contribute (or have his or her employer contribute) to an HSA if he or she participates in ...

A Sigh of Relief For Employers Subject to Potential ACA Disparate Impact Discrimination Claims

In the aftermath of Title VI of the Civil Rights Act of 1964, litigants have pressed courts on what conduct meets the criteria for a disparate impact discrimination claim. Typically, a disparate impact discrimination claim contends that a facially neutral employment practice has a discriminatory effect on a protected class of people such as race, gender, or age. In contrast to traditional ...

Was The Court of Claims Correct for the Wrong Reason?

In Iowa Bankers Benefit Plan v. United States, the Court of Federal Claims decided that the Iowa Bankers Benefit Plan, a group health arrangement, is within the Affordable Care Act ("ACA") definition of a "covered entity" under Section 9010 of the ACA, subject to the annual fee on health insurance providers. Section 9010 of the ACA is not codified, but is interpreted by the IRS regulation at 26 ...

HHS Guidance on When One Health Plan May Share PHI of Individuals with Another Health Plan

HHS has issued FAQs that provide guidance on the circumstances under which HIPAA's Privacy Rule allows for one health plan to share protected health information ("PHI") about individuals who "have a relationship" with a second health plan. Background. HIPAA's Privacy Rule allows a covered entity ("CE"), including a health plan, to disclose PHI to another CE for either: (i) the health plan's own ...

Agencies Expand HRA Availability to Provide Coverage

In response to an Executive Order from President Trump, the DOL, HHS, and the IRS proposed new regulations to expand the use of HRAs to pay for certain medical expenses.  They now have released final regulations that will be published in the Federal Register on June 20, 2019.  The final regulations, which will become effective January 1, 2020, provide for two new types of HRAs. Excepted Benefit ...