On March 10, 2024, the plaintiffs filed an amended complaint in a much-followed putative class action lawsuit against Johnson & Johnson (“J&J”) alleging that the plan fiduciaries for J&J’s group health plan violated ERISA by...more
Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more
Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more
Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more
On May 13, 2024, the Eleventh Circuit Court of Appeals held that certain federal non-discrimination protections apply to transgender individuals in the group health plan (insured and self-insured) context. In particular, the...more
On April 29, 2024, the Department of Labor (“DOL”) released a final regulation (the “Final Rule”) that rescinded the Trump Administration rule that expanded the availability of association health plans (“AHPs”) (“Trump DOL...more
On March 28, 2024, the Departments of Labor, Treasury, and Health and Human Services (the “Tri-Agencies”) issued final regulations on short-term, limited-duration insurance (“STLDI”), hospital and other fixed indemnity...more
On January 16, 2023, the Department of Health and Human Services (“HHS”) dropped its appeal of the U.S. District Court for the District of Columbia’s September 29, 2023 decision that vacated a portion of the 2021 Notice of...more
On September 29, 2023, the U.S. District Court for the District of Columbia vacated the 2021 Notice of Benefit and Payment Parameters (“2021 NBPP”) amendments to Affordable Care Act regulations. The amendments permitted (but...more
On July 25, 2023, the Departments of Health and Human Services, Labor and Treasury (“Tri-Agencies”) issued sweeping new guidance on the Mental Health Parity and Addiction Equity Act (“MHPAEA”), including a Proposed Rule, a...more
On July 7, the Departments of Labor, Treasury, and Health and Human Services (the “Tri-Agencies”) published a long-anticipated proposed rule (“Proposed Rule”) that...more
CMS published the Calendar Year (“CY”) 2024 Medicare Advantage (“MA”) Capitation Rates and Part C and Part D Payment Policies (“Rate Announcement“) on March 31 and, five days later, issued the MA and Part D final rule for...more
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
4/3/2023
/ Affordable Care Act ,
Constitutional Challenges ,
Cost-Sharing ,
Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Healthcare ,
Non-Grandfathered Health Plans ,
Preventive Health Care ,
Religious Freedom Restoration Act (RFRA) ,
Vacated
More than four years after it was proposed, on February 1, 2023 the Centers for Medicare & Medicaid Services (CMS) published the long-awaited risk adjustment data validation (RADV) Final Rule (Final Rule) that will affect...more
2/24/2023
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Extrapolation ,
Fee-for-Service ,
Final Rules ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Risk Adjustment Formula
Last week the Senate passed the Continuing Appropriations Act, 2023 (“CAA23”). The House of Representatives will likely consider the measure today, and President Biden is expected to sign the bipartisan measure into law...more
12/26/2022
/ Employee Benefits ,
Employer Group Health Plans ,
Health Insurance ,
Health Savings Accounts ,
Healthcare ,
Healthcare Reform ,
HSA ,
Medicaid ,
Medicare ,
Medicare Secondary Payer Act ,
Mental Health Parity Rule ,
Pending Legislation ,
Regulatory Agenda ,
Telehealth
On July 1, 2021, the Office of Personnel Management, Department of the Treasury, Department of Health and Human Services (“HHS”), and Department of Labor (“DOL”) (collectively, the “Departments”), released the interim final...more
The Mental Health Parity and Addiction Equity Act of 2008’s (“MHPAEA”) provisions of the Consolidated Appropriations Act, 2021 (the “CAA”) became effective February 10, 2021 and added a requirement for group health plans and...more
This webinar will include a discussion on the various provisions of the new surprise billing law, how it interacts with current law, expected guidance from the Biden Administration, and implications for health insurance...more
1/6/2021
/ Biden Administration ,
Health Care Providers ,
Health Insurance ,
Health Plan Sponsors ,
Healthcare Reform ,
Hospitals ,
New Legislation ,
Out of Network Provider ,
Physicians ,
Surprise Medical Bills ,
Webinars
In the recently-decided Rutledge v. Pharmaceutical Care Management Association (“PCMA”), the Supreme Court found 8–0 (Justice Barrett did not take part) that ERISA did not preempt an Arkansas state law that established...more
1/5/2021
/ Corporate Counsel ,
Drug Pricing ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Preemption ,
Prescription Drug Coverage ,
Prescription Drugs ,
Rutledge v Pharmaceutical Care Management Association ,
SCOTUS
The dust has settled and the 2020 election has concluded with former Vice President Biden poised to become president. At the same time, Democratic control of the House of Representatives has narrowed to the smallest margin...more
Regular readers of this Benefits Brief will recall that there is a case challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA) percolating through the courts. ...more
The House of Representatives recently passed a fourth round of legislation in response to the COVID-19 pandemic. The bill – called the Health and Economic Recovery Omnibus Emergency Solutions Act (the “HEROES Act” or the...more
6/1/2020
/ CARES Act ,
COBRA ,
Coronavirus/COVID-19 ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Families First Coronavirus Response Act (FFCRA) ,
Health and Welfare Plans ,
Health Insurance ,
Legislative Agendas ,
Pensions ,
Relief Measures ,
Retirement Plan
As you may recall, in late September, we expected a decision from the Fifth Circuit in Texas v. United States—the case challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA)—in the fall of...more
1/10/2020
/ Affordable Care Act ,
Appeals ,
Case or Controversy ,
Congressional Authority ,
Constitutional Challenges ,
Department of Justice (DOJ) ,
Health Insurance ,
Individual Mandate ,
Intervenors ,
Motion to Expedite ,
Penalties ,
Petition for Writ of Certiorari ,
Remand ,
SCOTUS ,
Severability Doctrine ,
Shared Responsibility Rule ,
Standing ,
Tax Penalties