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Technical Guidance Issued on Transparency in Coverage Regulations

On April 19, 2022, the U.S. Departments of Health and Humans Services, Labor, and Treasury (collectively, the Departments) issued guidance which sets forth two separate safe harbors for group health plans and health insurance...more

Provider's Claims for COVID-19 Screening Charges Move Forward

Addressing motions to dismiss, a district court in Texas has found that a provider may proceed with its lawsuit to recover the full amount of its charges for COVID-19 diagnostic testing under the FFCRA and CARES Act from an...more

The CAA's New Identification Card Requirements

Summary - To help individuals better understand the costs they will bear for medical care, the Consolidated Appropriations Act (CAA) requires health plan ID cards to include clear information about deductibles and...more

Understanding the New Continuity of Care Rule

Summary - Under a new rule introduced by the Consolidated Appropriations Act, 2021 (CAA), a health plan or insurer must offer an enrollee the opportunity to elect a transitional period of continued care with a provider...more

Understanding the New Health Care Transparency Requirements

Summary - New rules require group health plans and insurers to disclose pricing information in three phases. This is the third briefing in Ballard Spahr’s series on the Consolidated Appropriations Act, 2021 (CAA) and...more

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

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

CMS Addresses Extended Deadlines for Benefit Plans

The Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) has followed the guidance, jointly issued by the U.S. Departments of Labor and the Treasury, that extends benefits-related deadlines...more

IRS Provides Flexibility for Employer-Sponsored Health Plans and FSAs in Response to COVID-19 Pandemic

The Internal Revenue Service (IRS) has issued new guidance, Notice 2020-29, in response to the COVID-19 pandemic, providing for temporary flexibility with respect to mid-year elections made during 2020 under Code section 125...more

CMS Encourages Flexibility in Utilization Management and Prior Authorization Within Limits

The Centers for Medicare & Medicaid Services (CMS) issued FAQ guidance encouraging health insurers to relax their utilization management and prior authorization requirements in view of the COVID-19 pandemic while at the same...more

Treasury Recognizes Preventive Care for Chronic Conditions Under High Deductible Health Plans

Pursuant to a directive in last month’s Executive Order 13877, the Treasury Department issued guidance last week that lists particular preventive care items and services that may be covered by a high deductible health plan...more

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