Texas Court Invalidates ACA’s Free Preventive Care Requirement Nationwide

A Texas federal judge has struck down the portion of the Affordable Care Act (ACA) that requires insurers and employers to provide free preventative care services, such as contraception, as well as screenings for cancer, heart disease, HIV, and other diseases. The judge also found in his decision that requiring coverage of PrEP for HIV violates the Religious Freedom Restoration Act (RFRA). The ruling in Braidwood Read More

IRS Rev. Proc. 2023-17: Adjustments Under Section 4980H to Calculate 2024 Employer Shared Responsibility Payments

The Internal Revenue Service (IRS) has released IRS Rev. Proc. 2023-17, which provides indexing adjustments for the applicable dollar amounts under § 4980(H)(a) and (b)(1). These indexed amounts are necessary to calculate the employer-shared responsibility payments (ERSP) under these sections. This revenue procedure is effective for taxable and plan years beginning after December 31, 2023. The IRS based on the Read More

ERISA Class Action Lawsuit Claims Cigna Overcharged Members

Cigna Health and Life Insurance Co. is facing an ERISA class action lawsuit in Connecticut District Court, in which proposed class members alleged that the insurance company is overcharging for medical services. Although Cigna claims that it negotiates with in-network providers for lower rates to help their insureds save money, the proposed class members claim that Cigna engaged in a fraudulent scheme and that they Read More

Federal Agencies Issue FAQs (Part 57) to Provide Guidance on Gag Clause Ban for Group Health Plan Agreements

The DOL, IRS, and HHS have issued joint FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 57. These FAQs address certain provisions of the Consolidated Appropriations Act, 2021 (CAA, 2021) that ban so-called "gag clauses" or any provisions in group health plan agreements that preclude certain disclosures of provider-specific cost or quality-of-care information. Previously, Read More

CMS Delays Final Regulations on Civil Penalties for Violations of MSP Reporting Requirements

The Centers for Medicare & Medicaid Services (CMS) has pushed back the deadline by one year for issuing final regulations concerning the imposition of civil penalties for violations of Medicare Secondary Payer (MSP) reporting requirements. Responsible reporting entities (RREs) for group health plans, typically insurers or third-party administrators, must report certain information to CMS about individuals with Read More

DOL Fiduciary Rulemaking in Jeopardy Amidst Recent Court Rulings

Two recent federal court decisions, one in Florida and one in New York, have cast significant doubt on the ability of the U.S. Department of Labor (DOL) to issue and enforce formal regulations defining who qualifies as a fiduciary under federal benefits law. In its latest regulatory agenda, the DOL’s Employee Benefits Security Administration (EBSA) indicated that it intended to issue a new proposed rule explaining Read More

HHS Suspends, Restarts Surprise Medical Billing IDR Payment Determinations Following Agency Updates

After a Texas federal court vacated a portion of the final regulations on the surprise billing independent dispute resolution (IDR) process, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) ordered certified IDR entities to stop issuing new IDR payment determination pending further agency guidance. In addition, as per the Court's order, CMS also recalled Read More

Ninth Circuit Appears Skeptical of DOL Arguments in Atty Fee Battle

A three-judge panel of the U.S. Court of Appeals for the Ninth Circuit recently heard oral arguments in an architecture firm’s appeal of a district court judge’s order denying its attorney fees. Bowers + Kubota Consulting Inc. sought attorney fees against the U.S. Department of Labor (DOL) in an ERISA suit in which it prevailed. The case is Martin Walsh v. Brian Bowers et al., case number 22-15378, U.S. Court of Read More

Federal Court Partially Invalidates DOL’s ERISA Guidance

A Florida federal district court judge partially granted a securities industry group’s motion for summary judgment, in which it sought to invalidate certain ERISA guidance from the U.S. Department of Labor (DOL). The case is American Securities Association v. U.S. Department of Labor et al., case number 8:22-cv-00330, U.S. District Court for the Middle District of Florida. In her ruling, the judge found that FAQ 7 Read More

Federal Transparency Legislation Leads to Systemic Health Care Changes in 2023

The 2020 Consolidated Appropriations Act (CAA) laid out new transparency responsibilities for hospitals and payers, including removing all gag clauses limiting data access and utilization. Benefits advisors should prepare, plan, and take all steps necessary to ready their plan sponsor clients for these major changes in the healthcare landscape. The newly available hospital and payer transparency (HPT) will allow plan Read More