The Fifth Circuit Court of Appeals recently upheld regulations defining the qualifying payment amount (QPA). The QPA is a key factor in determining how much individuals and health plans must pay out-of-network providers in...more
Regulations under Section 1557 of the Affordable Care Act and HIPAA will require health plans and health care providers to take action in the coming months to meet new requirements. Health plan sponsors and providers that...more
Over the course of the past few months, the Office of Civil Rights (OCR) and the Office of the National Coordinator for Health Information Technology (ONC), both of which are divisions of the U.S. Department of Health and...more
6/28/2024
/ Cyber Attacks ,
Cybersecurity ,
Data Breach ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
HIPAA Breach ,
Information Technology ,
OCR ,
ONC ,
Personally Identifiable Information ,
PHI ,
Reproductive Healthcare Issues
The U.S. Department of Health and Human Services (HHS) has issued final regulations on the nondiscrimination rules set forth in Section 1557 of the Affordable Care Act. The new rules apply to certain group health plans, as...more
6/19/2024
/ Affordable Care Act ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employees ,
Employer Liability Issues ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare ,
Medicare ,
New Rules ,
Proposed Rules ,
Sex Discrimination
You are the HIPAA privacy official of a hospital or health plan (a covered entity under HIPAA). You receive an email from a vendor that handles protected health information (a business associate), informing you that one month...more
1/5/2024
/ Cybersecurity ,
Data Breach ,
Data Privacy ,
Data Protection ,
Data Security ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Personally Identifiable Information
The United States Department of Health and Human Services (HHS) has filed court pleadings stating that it does not intend to initiate enforcement actions against plans that maintain copay accumulator programs....more
12/11/2023
/ Affordable Care Act ,
Co-payments ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employees ,
Employer Group Health Plans ,
Enforcement Guidance ,
Final Rules ,
Health Insurance ,
Healthcare ,
Non-Enforcement ,
Pharmaceutical Industry ,
Prescription Drugs ,
Rulemaking Process
Summary -
The rules in the Consolidated Appropriations Act that aim to eliminate much of the surprise from billings by out-of-network providers in particular situations are the subject of continued controversy....more
10/24/2023
/ Billing ,
Consolidated Appropriations Act (CAA) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Life Sciences ,
Medical Bills ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Surprise Medical Bills
Summary -
The Departments of Labor, Health and Human Services, and the Treasury have proposed regulations under the Mental Health Parity Act that build on prior guidance to set forth requirements for an extremely detailed...more
8/16/2023
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Health Insurance ,
Healthcare ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Regulation ,
Proposed Rules ,
U.S. Treasury
Summary -
On July 25, 2023, the Departments of Labor, Treasury, and Health & Human Services (the Departments) released joint proposed regulations and other guidance under the Paul Wellstone and Pete Domenici Mental Health...more
8/1/2023
/ Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Health Insurance ,
Healthcare ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
NQTLs ,
Proposed Regulation ,
Proposed Rules ,
U.S. Treasury
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
The Fifth Circuit Court of Appeals has stayed the broad application of a district court decision that would have invalidated a number of preventive care requirements under the Affordable Care Act. As a result, health plans,...more
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
4/19/2023
/ Advisory Committee ,
Affordable Care Act ,
Biden Administration ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Health Insurance ,
Healthcare ,
HRSA ,
New Guidance ,
Preventive Health Care
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
Summary -
The almost three-year-old COVID-19 national emergency and public health emergency declarations (Declarations) are slated to expire May 11, 2023....more
The Office of Civil Rights of the Department of Health and Human Services has announced settlements with three different Boston-area hospitals for allegedly compromising the privacy of protected health information by inviting...more
9/25/2018
/ Data Breach ,
Department of Health and Human Services (HHS) ,
Entertainment Industry ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
HIPAA Breach ,
Hospitals ,
OCR ,
Personally Identifiable Information ,
PHI ,
Settlement ,
Television Programming
A celebrity collapses on stage and is rushed to the hospital. Rumors race through social media faster than the ambulance can navigate city streets. Was it exhaustion? Was it her heart? Was there a gunshot? ...more
Changes are imminent for the Affordable Care Act and a range of other laws and regulations affecting the health care industry. Ballard Spahr attorneys established a Health Care Reform Initiative in 2008 to monitor and analyze...more
1/20/2017
/ AARP ,
Abortion ,
Affordable Care Act ,
Age Discrimination ,
Americans with Disabilities Act (ADA) ,
Birth Control ,
Claim Procedures ,
COBRA ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Disability Benefits ,
Disability Discrimination ,
Discrimination ,
Employee Benefits ,
Employer Mandates ,
Equal Employment Opportunity Commission (EEOC) ,
Form 1094 ,
Form 1095 ,
Gender Discrimination ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare ,
Healthcare Reform ,
HRA ,
IRS ,
National Origin Discrimination ,
Public Health Insurance Marketplace ,
Religious Exemption ,
Religious Freedom Restoration Act (RFRA) ,
Reporting Requirements ,
Section 1557 ,
Sex Discrimination ,
Title IX ,
Trump Administration ,
Wellness Programs ,
Women's Preventable Healthcare Mandates
The Cures Act aims to increase the speed by which new drugs are brought to market by streamlining clinical trials, allowing the use of patient data in the regulatory review process, and modernizing U.S. Food and Drug...more
12/16/2016
/ 21st Century Cures Initiative ,
Addiction Equity Act ,
Affordable Care Act ,
Benefit Plan Reimbursements ,
Clinical Trials ,
Employee Benefits ,
Federal Funding ,
Food and Drug Administration (FDA) ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Medicaid ,
Medical Devices ,
Medical Research ,
Medicare ,
Mental Health ,
Mental Health Parity Rule ,
New Legislation ,
Obama Administration ,
Pharmaceutical Industry ,
Prescription Drugs ,
Regulatory Oversight ,
Research and Development
The Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) has posted an alert (and a follow-up alert) warning health plans, health care providers, and their vendors of a mock communication...more
12/1/2016
/ Cybersecurity ,
Data Security ,
Department of Health and Human Services (HHS) ,
Electronic Medical Records ,
Email ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
HIPAA Audits ,
OCR ,
PHI ,
Phishing Scams
The IRS has extended the deadline for furnishing 2016 Forms 1095-C and 1095-B to individuals by 30 days to March 2, 2017. The reprieve offers welcome relief to employers, health insurers, and other plan sponsors who would...more
11/21/2016
/ Affordable Care Act ,
Deadlines ,
Employee Benefits ,
Employer Mandates ,
Form 1094 ,
Form 1095 ,
Health Insurance ,
Healthcare ,
IRS ,
Reporting Requirements ,
Time Extensions
The U.S. Departments of Labor, Health and Human Services, and the Treasury have issued a set of Frequently Asked Questions and Answers that, among other things, implement certain of the recommendations included in a report...more
11/7/2016
/ Affordable Care Act ,
Data Collection ,
Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Healthcare ,
Mental Health Parity Rule ,
MHPAEA ,
Opioid ,
Prescription Drugs ,
Tobacco ,
Tobacco-Cessation
The U.S. Departments of Labor, Health and Human Services, and the Treasury have finalized regulations under the Affordable Care Act (ACA) that address certain exceptions under the ACA. Among other things, the regulations...more
As we start looking forward to 2017, and as many employers head into annual enrollment periods this fall, employers need to be aware of recent changes in the law that have a significant impact on health benefit plans. This...more
9/28/2016
/ Affordable Care Act ,
Americans with Disabilities Act (ADA) ,
Department of Health and Human Services (HHS) ,
Employee Benefits ,
Employer Mandates ,
Form 1094 ,
Form 1095 ,
Genetic Discrimination ,
GINA ,
Health Insurance ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Healthcare ,
Healthcare Reform ,
HIPAA Audits ,
IRS ,
Non-Discrimination Rules ,
Opt-Outs ,
Reporting Requirements ,
Wellness Programs
The IRS has issued proposed regulations on the individual mandate reporting requirements under section 6055 of the Internal Revenue Code. To a significant degree, the new regulations reflect guidance previously published by...more
8/4/2016
/ Affordable Care Act ,
Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Healthcare ,
Individual Mandate ,
Internal Revenue Code (IRC) ,
IRS ,
Minimum Essential Coverage ,
Reporting Requirements ,
Section 6055 ,
Section 6056
Following up on the issuance of final regulations on various market reform provisions under the Affordable Care Act (ACA), the IRS has issued a notice with Questions and Answers that take a more detailed look at specific ACA...more