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All News > Health Plan Policy

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Senate Confirms Lisa Gomez as EBSA Leader
Pensions & Investments Link to more items from this source
Sept. 30, 2022

"More than 14 months after her nomination, the Senate on [September 29] confirmed Lisa M. Gomez as assistant secretary of labor for the Employee Benefits Security Administration [EBSA] in a 49-36 vote."

Tags: Health Plan Policy  •  Retirement Plan Policy

The Importance of Preserving Preventive Care in the ACA (PDF)
Committee on Education and Labor, U.S. House of Representatives Link to more items from this source
[Opinion]
Sept. 29, 2022

"A recent decision by a very conservative court, issued by a very conservative judge, jeopardizes the future of these critical reforms for millions of individual consumers, small business owners, workers, and their families.... This case is ongoing, and the decision will hopefully be overturned on appeal, but the stakes for American workers and families are high. Preventive service coverage has been enormously consequential in improving access to care for millions of Americans and it is critical that this protection be preserved."

Tags: Health Plan Design  •  Health Plan Policy

HRSA's Confusing, Out-of-Date Guidance Undermines Contraceptive Coverage and Access
Health Affairs Forefront Link to more items from this source
[Opinion]
Sept. 28, 2022

"Access to certain contraceptives is already at risk due to the Dobbs decision: The HRSA and the Biden administration at-large should take all reasonable steps to ensure maximum access to the widest possible array of effective contraceptives, as was intended by the ACA."

Tags: Health Plan Design  •  Health Plan Policy

HRPA Letter to Congress Expressing Concerns with the Restore Protections for Dialysis Patients Act (PDF)
HR Policy Association [HRPA] Link to more items from this source
[Opinion]
Sept. 23, 2022

"The legislation [S 4750] is unnecessary because a variety of federal requirements already protect ESRD patients from losing their employer-provided health care benefits.... The legislation also creates a completely unworkable parity requirement for patients with end stage renal disease (ESRD).... The bill fails to account for different medical practice standards, treatment needs, and value-based benefit designs for widely varying chronic medical conditions and incorrectly assumes or implies that, from a medical perspective, all chronic conditions are and should be treated exactly the same."

Tags: Health Plan Policy  •  Medicare

Will SCOTUS Strike Down the ACA's Preventive Services Coverage Requirement?
Richard Hughes IV, Nija Chappel and William Walters, via Health Affairs Forefront Link to more items from this source
[Opinion]
Sept. 23, 2022

"Should the decision be affirmed on appeal to the Fifth Circuit and reach the US Supreme Court, a majority of the justices could conceivably decide that, at a minimum, Section 2713 impermissibly delegates authority to the USPSTF ... The current Court is apt to restrain Congress's ability to farm out work that a majority of the justices view as the province of legislatures to the federal agencies or advisory committees. Therefore, the ACA's preventive services coverage requirement faces a near certain path to some degree of judicial curtailment." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Policy

Federal Court Finds Key Part of ACA's Preventive Service Mandate Unconstitutional
The Wagner Law Group Link to more items from this source
Sept. 22, 2022

"The court found that [U.S. Preventive Services Task Force (USPTF)] members were principal officers who must be nominated by the President and confirmed by the Senate. The court noted that USPTF was not part of HHS or another agency and its members are not directed or supervised by someone appointed by the President and confirmed by the Senate. Therefore, because the USPTF members were not properly appointed, the court held that their appointments violated the Appointments Clause." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

Text of EBSA Meeting Notice for ERISA Advisory Council
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
Sept. 22, 2022

"[T]he 212th open meeting of the Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) will be held via a teleconference on Tuesday, October 18, 2022.... The purpose of the open meeting is for the members of the ERISA Advisory Council to discuss potential recommendations for the Secretary of Labor on the issues of: [1] Cybersecurity Issues Affecting Health Benefit Plans, and [2] Cybersecurity Insurance and Employee Benefit Plans. Descriptions of these topics are available on the ERISA Advisory Council's web page[.]"

Tags: Cybersecurity  •  Health Plan Policy  •  Retirement Plan Policy

Judge Denies U.S. Bid to Stop UnitedHealth Group's Plan to Buy Change Healthcare
Reuters; free registration may be required Link to more items from this source
Sept. 21, 2022

"Judge Carl Nichols said in a brief order on Monday that he would deny the government's request to stop the deal, and ordered the companies to go forward with an asset sale that they had proposed." [U.S. v. UnitedHealth Group Inc. and Change Healthcare Inc., No. 22-0481 (D.D.C. Sep. 19, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

Hill Healthcare Agenda Stalls as Midterm Elections Loom
Mercer Link to more items from this source
Sept. 16, 2022

"[A] short-term funding fix set to run to December probably won't include proposals to extend temporary telehealth flexibilities for employers, improve mental health care and provide more COVID-19 aid.... [A]ction on these issues now isn't likely until late this year in a crowded lame-duck session, complicating the outlook for final passage."

Tags: Health Plan Design  •  Health Plan Policy

Texas District Court Judge Finds ACA Preventive Services Requirement Invalid
The Commonwealth Fund Link to more items from this source
Sept. 15, 2022

"Judge O'Connor did not immediately issue an order blocking enforcement of the coverage requirements. He also did not specify whether such an order would be nationwide, for his district only, for all the named plaintiffs, or only for Braidwood. These issues are held for further argument before Judge O'Connor." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

'Probate Exception' Precludes Federal Jurisdiction Over ERISA Lawsuit
The Wagner Law Group Link to more items from this source
Sept. 14, 2022

"As plan sponsor for the group health plan, the plaintiff subsequently filed an ERISA action in federal district court seeking an equitable lien by agreement over the wrongful death settlement funds in the possession of the decedent's estate, in order to recoup the funds the plan paid for the beneficiary's accident-related medical treatment.... [T]he district court concluded that the relief the plaintiff's ERISA claim sought would interfere with the distribution process approved by the probate court for the settlement funds, thus triggering the probate exception." [American Electric Power Service Corporation v. Fitch, No. 22-3005 (6th Cir. Aug. 30, 2022; unpub.)]

Tags: Health Plan Policy

District Court: ACA's HIV/Prep Coverage Mandate Violates Religious Freedom Restoration Act
Thomson Reuters Practical Law Link to more items from this source
Sept. 12, 2022

"In a dispute involving the [ACA's] preventive health services rules, a Texas district court held that the coverage mandate for preexposure prophylaxis (PrEP) drugs to prevent HIV infections violated an employer's rights under the Religious Freedom Restoration Act of 1993 (RFRA). The district court also addressed the appointment process for the entities that determine which items and services must be covered under the ACA's preventive health services rules, as implemented." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

Fifth Circuit Case Carries Significant Implications for Health Plan Regulation
Groom Law Group Link to more items from this source
Sept. 12, 2022

"If arrangements like Data Marketing are legitimate single employer ERISA-covered health plans, other similar arrangements could proliferate. The Data Marketing plan operates much like an insurance company offering individual market coverage to persons with no employment relationship to each other or to Data Marketing (beyond downloading an app). These plans are exempt from many consumer protections under the [ACA] ... They would also be exempt from state insurance laws, including financial solvency regulation." [Data Marketing Partnership, LP v. DOL, No. 20-11179 (5th Cir. Aug. 17, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

Many Preventive Medical Services Cost Patients Nothing, But a Federal District Court Decision Could Change That
Kaiser Health News Link to more items from this source
Sept. 9, 2022

"A key part of the ruling by Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas says one way that preventive services are selected for the no-cost coverage is unconstitutional. Another portion of his ruling says a requirement that an HIV prevention drug therapy be covered without any cost to patients violates the religious freedom of an employer who is a plaintiff in the case. It is not yet clear what all this means for insured patients. A lot depends on what happens next." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

District Court Holds That Key ACA Preventive Services Requirements Are Unconstitutional
Health Affairs Forefront Link to more items from this source
Sept. 9, 2022

"Judge O'Connor held that a key part of the preventive services mandate -- namely, the requirement that most commercial plans cover services with an 'A' or 'B' recommendation from the U.S. Preventive Services Task Force (USPSTF) without cost sharing -- violates the Appointments Clause and is thus unconstitutional. He also ruled that the requirement that insurers and plans cover an HIV prevention medication known as preexposure prophylaxis (PrEP) violated one plaintiff's rights under the Religious Freedom Restoration Act (RFRA)." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

District Court: HHS Process for Determining Whether Preventative Services Are Covered by the ACA Is Unconstitutional
ProMagazine Link to more items from this source
Sept. 8, 2022

"[A] federal judge in Fort Worth agreed with a group of Christian conservatives that the ACA's mandate that insurance plans cover HIV preventive medications violates their religious freedom.... Judge Reed O'Connor concluded that the government's process for determining whether preventative services are covered by the ACA is unconstitutional." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

Next Steps in Expanding Health Coverage and Affordability
The Commonwealth Fund Link to more items from this source
Sept. 7, 2022

"[This study analyzes] the impact of five policies for expanding coverage and affordability after the extension of ARPA subsidies. The five options include: [1] filling the Medicaid gap in nonexpansion states; [2] reducing the employer affordability threshold; [3] adding a $10 billion reinsurance fund; [4] increasing the federal Medicaid matching rate in expansion states; and [5] enhancing and funding marketplace cost-sharing subsidies."

Tags: Health Plan Costs  •  Health Plan Design  •  Health Plan Policy

CRS Legal Sidebar: Proposed HHS Rule Addressing Section 1557 of the ACA's Incorporation of Title IX
Congressional Research Service [CRS] Link to more items from this source
[Guidance Overview]
Sept. 6, 2022

"While the 2022 NPRM proposes various changes, this Legal Sidebar discusses HHS's position on several legal issues that arose in this earlier litigation and that are addressed in the 2022 NPRM, over how to interpret the precise scope and meaning of Section 1557's incorporation of another statute -- Title IX of the Education Amendments of 1972. Title IX, among other things, prohibits discrimination 'on the basis of sex' in federally funded education programs or activities." [LSB10813 Sep. 2, 2022]

Tags: Health Plan Design  •  Health Plan Policy

Fifth Circuit Rules Invalidates DOL Advisory Opinion That Health Plan Was Not Subject to ERISA
Proskauer Link to more items from this source
Aug. 29, 2022

"[T]he Fifth Circuit reasoned that the advisory opinion was arbitrary and capricious because it relied on a definition of 'working owner' that was 'materially different' from the one applied in prior guidance. The Fifth Circuit held that the DOL's failure to explain its departure from the prior definition resulted in the kind of 'unexplained inconsistency' that is the 'hallmark' of arbitrary and capricious agency action." [Data Marketing Partnership, LP v. DOL, No. 20-11179 (5th Cir. Aug. 17, 2022)]

Tags: Health Plan Design  •  Health Plan Policy

District Court Upholds Constitutionality of 'No Surprises Act'
Health Affairs Forefront Link to more items from this source
Aug. 19, 2022

"On August 10, 2022, a federal district court upheld the No Surprises Act (NSA) against a challenge brought by a New York surgeon who argued that major parts of the law were unconstitutional.... This article summarizes this decision -- the third ruling in NSA-related litigation[.]" [Haller v. HHS, No. 21-7208 (E.D.N.Y. Aug. 10, 2022)]

Tags: Health Plan Costs  •  Health Plan Policy

Text of EBSA Request for Nominations: Advisory Council on Employee Welfare and Pension Benefit Plans
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
[Official Guidance]
Aug. 18, 2022

"The terms of five Council members expire at the end of this year. The groups or fields they represent are as follows: [1] Employee organizations; [2] employers; [3] the general public; [4] insurance; and [5] accounting.... Nominations must be received on or before [45 days after publication in the Federal Register, currently scheduled for August 19, 2022]."

Tags: Health Plan Policy  •  Retirement Plan Policy

Inflation Reduction Act's Health Care Provisions Could Affect Employers
Society for Human Resource Management [SHRM]; membership may be required to view article Link to more items from this source
Aug. 16, 2022

"With the expansion of enhanced PTC subsidies until 2025, it becomes more likely that the higher subsidies will eventually be made permanent ... One consequence could be to make ACA marketplace plans a more appealing health care option for employers, who could opt to ... meet the ACA's coverage requirements by funding individual coverage health reimbursement arrangements (ICHRAs), which allow employees to purchase their own coverage on ACA exchanges."

Tags: Health Plan Costs  •  Health Plan Design  •  Health Plan Policy

Congress Paves the Way for Drug Pricing Reforms with Passage of the Inflation Reduction Act of 2022
Ropes & Gray LLP Link to more items from this source
Aug. 15, 2022

"The Bill's most important health care provisions include [1] establishing a new program for Medicare to directly negotiate prices with pharmaceutical manufacturers for certain high-spend Medicare drugs, with stiff penalties for companies that refuse; [2] requiring manufacturers to pay rebates on drugs reimbursed under Medicare Parts B or D for which average (i.e., net) prices increase faster than inflation; [3] revamping the Medicare Part D benefit, including establishing an annual out-of-pocket cap for beneficiary cost-sharing on prescription drugs and eliminating patient cost-sharing in the catastrophic phase; ... and [5] extending temporary expanded health insurance subsidies for ACA plans through 2025."

Tags: Health Plan Policy  •  Prescription Drug Costs

Proposed Oregon State Health Plan Would Raise Taxes $21 Billion Per Year
OregonReport Link to more items from this source
Aug. 15, 2022

"A draft plan for universal health care in Oregon would raise taxes on the state's businesses and residents by more than $20 billion per year.... The health plan would be funded by an employer payroll tax that would collect about $12 billion in 2026 and by a personal income tax that would collect about $10 billion.... Oregon's business tax burden is among the country's 20 highest, and the combined state and local income tax rate in the Portland area is the nation's fourth highest. Meanwhile, more than 95% of Oregonians already have access to health care."

Tags: Health Plan Costs  •  Health Plan Policy  •  Local Regulation

President Biden Issues Second Executive Order Responding to Dobbs Decision
Thomson Reuters Practical Law Link to more items from this source
Aug. 5, 2022

"The White House ... executive order announces a policy of supporting women's ability to access reproductive health care by traveling to seek abortion care in states where it is legal."

Tags: Health Plan Design  •  Health Plan Policy

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