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Cost-Sharing Healthcare Health Insurance

McDermott+

Breaking Down the New No Surprises Act FAQs Post-TMA III

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On January 14, 2025, the US Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments), along with the Office of Personnel Management (OPM), jointly issued Part 69 of a series of...more

ArentFox Schiff

Massachusetts Enacts Drug Pricing Legislation: Introducing PBM Licensure, Mandatory Cost Reporting, and Consumer Cost-Sharing...

ArentFox Schiff on

On January 8, Massachusetts Governor Maura Healy signed into law “An Act Relative To Pharmaceutical Access, Costs And Transparency.” The Act will have a profound impact on all parties involved in setting and applying drug...more

Seyfarth Shaw LLP

Agencies Release 2026 Out-of-Pocket Limits and 2025 Limits for Health FSAs

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Recently HHS issued a memorandum announcing the maximum annual limitation on cost sharing (a/k/a out-of-pocket maximum) for 2026 and the IRS issued Rev. Proc. 2024-40 announcing the cost-of-living adjustments to certain...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

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 …

Ballard Spahr LLP on

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

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

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

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

Venable LLP

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

Venable LLP on

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

Polsinelli on

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

Mintz - Health Care Viewpoints

Health Care Weekly Preview from ML Strategies – March 2018

Congress kicks off this week with three weeks to go before the March 23 omnibus spending deadline. At this point it’s still not entirely clear what will be tacked on to this spending package, but immigration, market...more

Mintz - Employment Viewpoints

Massachusetts to (Again) Require Health Care Reporting by Employers

Massachusetts employers with 6 or more employees will soon be required to prepare and file a new health care reporting form referred to as the “healthcare coverage form.” While reminiscent of the now repealed “Health...more

K&L Gates LLP

K&L Gates Triage: An Insider’s Perspective on the Health Care Debate in Washington, DC

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In this episode of Triage, Amanda Makki and Corbin Santo of the K&L Gates Public Policy and Law practice group discuss several fundamental issues that are currently at the center of the health care debate in Washington, DC....more

Holland & Knight LLP

Cost-Sharing Subsidies Ruling Adds More Uncertainty to Affordable Care Act

Holland & Knight LLP on

Holland & Knight issued an alert in May 2016 regarding litigation by the U.S. House of Representatives against the Obama Administration and the decision of the U.S. District Court for the District of Columbia enjoining any...more

Franczek P.C.

New Affordable Care Act FAQs Issued

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On October 23, the U.S. Department of Labor, the Department of Health and Human Services, and the Department of the Treasury (collectively, the “Departments”) jointly issued answers to frequently asked questions regarding the...more

Foley & Lardner LLP

Highlights from the Tenth CEO/Innovators Roundtable: June 4 – 5, 2015

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This past June, leaders from health systems, outpatient services companies, health insurers, IT and equipment suppliers, health retailers, home care providers, pharmaceutical companies, and investors gathered in Chicago for...more

Akerman LLP - Health Law Rx

Illinois Enacts Patient Notification Requirement for Observation Stays

Illinois joins a growing number of states to pass laws requiring that hospitals provide notice to patients who are placed under observation status. 210 ILCS 86/6.09b As with the recent federal NOTICE Act, the laws respond to...more

Mintz - Health Care Viewpoints

Medicare to Permit Value-Based Insurance Design in Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (“CMS”) recently announced that, beginning January 1, 2017, Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee will be permitted...more

Franczek P.C.

Final Rule Regarding Preventive Services Under ACA

Franczek P.C. on

The Department of the Treasury, DOL, and Department of Health and Human Services (HHS) issued final rules regarding coverage of certain preventive services required to be provided under ACA without cost sharing by...more

McGuireWoods LLP

Washington Healthcare Update

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This Week: House Energy and Commerce Subcommittee Holds Hearing on Legislation to Strengthen Medicaid Program Integrity and Fraud Controls... Bipartisan Senate Bill Introduced to Stop Anti-Competitive “Pay-For-Delay”...more

Epstein Becker & Green

New Value-Based Insurance Design Model for Medicare Advantage Plans Is the First of Multiple Medicare Plan Innovations Anticipated...

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On September 1, 2015, the Centers for Medicare & Medicaid Services (“CMS”) announced[1] the opportunity for plan sponsors to test value-based insurance design (“VBID”) in the Medicare Advantage (“MA”) market. VBID refers to...more

King & Spalding

CMS Announces New Value-Based Insurance Design Model for Medicare Advantage

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On September 1, 2015, CMS unveiled a new Medicare Advantage Value-Based Insurance Design (MA-VBID) model, which will allow Medicare Advantage plans to offer clinically-nuanced benefit packages aimed at improving quality of...more

King & Spalding

OIG Issues Advisory Opinion Regarding Pharmaceutical Manufacturers’ Program to Provide Free Limited Drugs to Beneficiaries When...

King & Spalding on

On August 12, 2015, the Department of Health and Human Services Office of Inspector General (OIG) posted Advisory Opinion No. 15-11, finding that a program to supply a limited amount of free cancer drugs to federal health...more

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