News & Analysis as of

Health Insurance New Guidance

Quarles & Brady LLP

Manufacturer Rebate Models: The Next 340B Program Battleground

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The 340B Drug Pricing Program (“340B Program”) space continues to be a hive of activity. While 340B stakeholders continue to litigate ongoing manufacturer contract pharmacy restrictions, states legislatures are enacting...more

Foley & Lardner LLP

Virginia Bureau of Insurance Issues Guidance Clarifying Material Change and Required Notifications for Managed Care Health...

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On July 22, the Virginia Bureau of Insurance (BOI) issued Administrative Letter 2025-02 (the Letter) to all licensed insurers writing Managed Care Health Insurance Plans (MCHIPs) in Virginia. The Letter clarifies what...more

Mintz - Health Care Viewpoints

CMS Sheds Light on its Timeline for Expedited RADV Audits

Shortly following its announcement of sweeping changes to RADV audits, CMS shared industry guidance last week regarding upcoming deadlines for the submission of risk adjustment data corrections in advance of RADV sampling....more

Pullman & Comley, LLC

IRS Announces HSA and HDHP Dollar Limits for 2026

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The IRS has announced the 2026 cost-of-living adjustments to the applicable dollar limits for health savings accounts (HSAs), high-deductible health plans (HDHPs), and excepted benefit health reimbursement arrangements...more

Stoel Rives - Health Law Insider®

IRS Announces HSA and HDHP Limits for 2026

The Internal Revenue Service has released Rev. Proc. 2025-19 announcing the inflation-adjusted limits for high deductible health plans (HDHPs) and health savings accounts (HSAs) in 2026.  The updated 2026 limits are as...more

Proskauer - Health Care Law Brief

DOH Issues Guidance on New York’s Material Health Care Transaction Law

Nearly two years ago, and as previously discussed in a Proskauer alert, New York enacted Public Health Law Article 45-A (the “Material Transactions Law”), which requires reporting of certain material health care transactions....more

McDermott+

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

McDermott+ on

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

Seyfarth Shaw LLP

HHS’ Withdrawal of 2022 Guidance Raises Questions about Coverage for Gender-Affirming Care

Seyfarth Shaw LLP on

In a move with potentially significant implications for entities subject to the Affordable Care Act, the Department of Health and Human Services (HHS) has reversed course and now contends that Section 1557 of the Affordable...more

Venable LLP

IRS Issues Guidance Regarding ACA Reporting

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Laws enacted at the end of 2024 made important changes to the ACA reporting requirements. The laws codified an alternative option for furnishing certain forms to individuals and authorized the IRS to issue new guidance on the...more

Ballard Spahr LLP

IRS Guidance Expands List of Preventive Care Benefits Under HDHPs

Ballard Spahr LLP on

The IRS recently issued Notices 2024-71 and 2024-75, which expand the list of “preventive care” benefits permitted to be provided by a high deductible health plan (HDHP) without a deductible and the list of benefits...more

Eversheds Sutherland (US) LLP

New IRS guidance expands list of preventive care benefits under a high deductible health plan

On October 17, 2024, the IRS published Notice 2024-75 (Notice), expanding preventive care benefits that can be provided under a high deductible health plan (HDHP) before an individual reaches the applicable minimum HDHP...more

Bass, Berry & Sims PLC

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

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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 & Schulte

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

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

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

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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

Proskauer - Employee Benefits & Executive...

For HDHPs, IRS Confirms Pre-Deductible COVID-19 Testing Coverage Will End Next Year

In the most recent sign that special COVID-19 benefit plan rules are drawing to a close, last Friday, the IRS issued Notice 2023-37, which clarifies the scope of COVID-19 testing and treatment that can be provided on a...more

Verrill

Gag Clauses – New Guidance and Litigation Will Inform Compliance

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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

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

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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

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