News & Analysis as of

Health Insurance New Guidance Department of Health and Human Services (HHS)

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

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

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

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

Verrill

Gag Clauses – New Guidance and Litigation Will Inform Compliance

Verrill on

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

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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

Ballard Spahr LLP

Unmuzzled: Time to Attest That No Gags Apply

Ballard Spahr LLP on

Summary - The Departments of Labor, Health and Human Services, and the Treasury have issued guidance on how health plans and insurers may attest to their compliance with the anti-gag rules of the Consolidated...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

HHS, DOL, and Treasury Give Employer-Sponsored Health Plans Another Warning on Providing Contraceptive Coverage

​​​​​​​Employers can’t say they weren’t warned. For the second time in six months, frequently asked question (FAQ) guidance from federal regulators is calling attention to the requirement that employer-sponsored health...more

Williams Mullen

At-Home COVID Tests Must be Reimbursed by Insurance Companies

Williams Mullen on

Group health plans and health insurance issuers are now required to cover the cost of over-the-counter (OTC) COVID-19 diagnostic tests. Last week, the Departments of Labor, Health and Human Services, and the Treasury issued...more

Harris Beach Murtha PLLC

Plans and Issuers Must Cover the Cost of OTC COVID-19 Tests (If You Can Find Them) by Saturday, January 15, 2022

On December 2, 2021, President Biden announced that the Departments of Labor, Health and Human Services (HHS) and the Treasury (the “Departments”) would issue guidance by January 15, 2022 to clarify that individuals who...more

Eversheds Sutherland (US) LLP

Plans and insurers must cover over-the-counter COVID-19 tests under new tri-agency guidance

Health plans and insurers must generally cover over-the-counter COVID-19 tests under Frequency Asked Questions (FAQs) issued on January 10 by the Departments of Labor, Treasury and Health and Human Services (tri-agencies)....more

Ogletree, Deakins, Nash, Smoak & Stewart,...

COVID-19 Testing Coverage Requirements for Group Health Plans and Insurers to Take Effect on January 15, 2022

Employer health plans and health insurers will be required to cover over-the-counter (OTC) COVID-19 tests, even without a health care provider’s order or an individualized clinical assessment, and generally without cost...more

Sheppard Mullin Richter & Hampton LLP

Tri-Agencies Release Guidance on Coverage of OTC COVID-19 Tests

On January 10, 2022, the U.S. Department of Health & Human Services, Department of Labor, and the Treasury (“Tri-Agencies”) published guidance about how health plans and health insurance issuers must reimburse OTC COVID-19...more

Stinson LLP

Agencies Issue COVID-19 Vaccine Incentive Guidance

Stinson LLP on

On October 4, 2021, the U.S. Department of Health and Human Services, U.S. Department of Labor and U.S. Department of the Treasury jointly issued FAQs relating to COVID-19 vaccine incentives and surcharges. Under the...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Federal Agencies Issue HIV Preventive Services Guidance for Health Benefit Plans

The U.S. Department of Labor, U.S. Department of Health and Human Services, and U.S. Department of the Treasury recently issued regulatory guidance on the requirement that health plans cover pre-exposure prophylaxis (PrEP)...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

New Guidance Delays Some Key CAA and Other Health Benefit Effective Dates

New regulatory guidance from three federal agencies that enforce private-sector benefits laws will make employers’ daunting 2021 health benefit to-do lists slightly - but only slightly - more manageable heading into 2022....more

Ogletree, Deakins, Nash, Smoak & Stewart,...

New Mental Health Parity Guidance and Enforcement Efforts May Warrant a Deep Dive Into Plan Administration

The Department of Labor (DOL), the Department of the Treasury, and the Department of Health and Human Services (HHS) are making good on their promise to issue more guidance and to aggressively enforce the federal Mental...more

Bass, Berry & Sims PLC

CMS Guidance Paves Way for Medicaid Work Requirements

Bass, Berry & Sims PLC on

The Centers for Medicare & Medicaid Services (CMS) started the year with a bang, issuing guidance on January 11, 2018, in support of Medicaid demonstration projects that condition coverage on beneficiary participation in work...more

Tucker Arensberg, P.C.

New Guidance on Coverage for Eating Disorders

Tucker Arensberg, P.C. on

The Departments of Labor, Treasury, and Health and Human Services recently released a frequently asked question (“FAQ”) regarding the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction...more

Proskauer - Employee Benefits & Executive...

New Affordable Care Act FAQs Provide Guidance on Preventive Services, Wellness Programs and Mental Health Parity

On October 23, 2015, the Departments of Labor, Health and Human Services and Treasury (the “Agencies”) jointly released their twenty-ninth (XXIX) set of Frequently Asked Questions (FAQs) about Affordable Care Act (ACA)...more

Franczek P.C.

New Affordable Care Act FAQs Issued

Franczek P.C. on

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

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