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Statement of DOL, HHS, and Treasury Department Regarding Enforcement of the Final Rule on Requirements Related to the Mental Health Parity and Addiction Equity Act (PDF)

"The Departments have requested that the ERIC litigation be held in abeyance while the Departments reconsider the 2024 Final Rule, including whether to issue a notice of proposed rulemaking rescinding or modifying the regulation through notice and comment rulemaking. The Departments will not enforce the 2024 Final Rule or otherwise pursue enforcement actions, based on a failure to comply that occurs prior to a final decision in the litigation, plus an additional 18 months. This enforcement relief applies only with respect to those portions of the 2024 Final Rule that are new in relation to the 2013 final rule. The Departments note that MHPAEA's statutory obligations, as amended by the CAA, 2021, continue to have effect.... The Departments will also undertake a broader reexamination of each department's respective enforcement approach under MHPAEA, including those provisions amended by the CAA, 2021." [ERIC v. HHS, No. 25-0136 (D.D.C. complaint filed Jan. 17, 2025; HHS motion for abeyance filed May 12, 2025, granted May 12, 2025)]

Text of Treasury Department and HHS Request for Information: State Relief and Empowerment Waivers

16 pages. "This RFI is intended to solicit ideas and spur additional thinking and innovation as states consider developing section 1332 waiver plans.... The Departments seek public comments on [1] ideas that states may be able to use to develop innovative waiver programs that meet the section 1332 guardrails.... [2] waiver concepts that states could potentially use alone or in combination with other waiver concepts, state proposals, or policy changes.... [3] ideas for waiver concepts that could advance some or all of the principles outlined in the October 2018 guidance and Background section [of this document].... [4] ideas for waiver concepts that incorporate the entire range of waivable requirements allowed under section 1332. The Departments are also interested in how states might align these flexibilities under section 1332 with other flexibilities under federal law, including regulatory flexibility, section 1115 Medicaid waivers, as well as state law."

Text of DOL, HHS and Treasury Department Proposed Regs: Amendments to Excepted Benefit

43 pages. Excerpt: "In response to [employer] concerns, and to level the playing field between insured and self- insured coverage, these proposed regulations would eliminate the requirement under the HIPAA regulations that participants pay an additional premium or contribution for limited-scope vision or dental benefits to qualify as benefits that are not an integral part of a plan (and therefore as excepted benefits). The Departments invite comments on this approach.... the Departments have developed these proposed regulations to treat certain wraparound coverage provided under a group health pl an as excepted benefits when it is offered to individuals who could receive such benefits through their group health plan if they could afford the premiums, but who do not enroll in the employer-sponsored plan because the premium is unaffordable under the law. As excepted benefits, the coverage would generally be exempt from the HIPAA and Affordable Care Act market reform requirements of ERISA, the PHS Act, and the Code. Wraparound coverage would only qualify as excepted benefits under limited circumstances ... hese proposed regulations set forth criteria for an EAP to qualify as excepted benefits beginning in 2015. Under these proposed regulations, benefits provided under EAPs are excepted if four criteria are met."

DOL, HHS and Treasury Issue Final Rule to Provide Greater Flexibility for Grandfathered Group Health Plans

"[T]he rule clarifies that grandfathered group health coverage that is a high deductible health plan (HDHP) may increase fixed-amount cost-sharing requirements, such as deductibles, to the extent necessary to maintain its status as an HDHP without losing grandfather status. This change ensures that participants and beneficiaries enrolled in that coverage remain eligible to contribute to a health savings account. Second, the final rule provides an alternative method of measuring permitted increases in fixed-amount cost sharing that allows plans and issuers to better account for changes in the costs of health coverage over time."

HHS and Treasury Department Approve Alaska's 1332 State Innovation Waiver Application

"Alaska sought a [State Innovation Waiver under the ACA (a '1332 Waiver')] to implement the Alaska Reinsurance Program (ARP) for 2018 and future years in an effort to stabilize the individual healthcare market.... The ARP is a state-operated program which covers claims in the individual market for people with one or more of 33 identified high cost conditions in order to help stabilize premiums for healthier participants.... Alaska projects that the ARP will reduce premiums by 20 percent in 2018, and more consumers may have coverage."

Text of CMS and Treasury Department Guidance: State Relief and Empowerment Waivers

34 pages. "This updated guidance provides supplementary information about the requirements that must be met for the approval of a State Innovation Waiver, the Secretaries' application review procedures, the calculation of pass-through funding, certain analytical requirements, and operational considerations.... Changes include increasing flexibility with respect to the manner in which a section 1332 state plan may meet section 1332 standards in order to be eligible to be approved by the Secretaries, clarifying the adjustments the Secretaries may make to maintain federal deficit neutrality, and allowing for states to use existing legislative authority to authorize section 1332 waivers in certain scenarios.... "The Secretaries will consider favorably section 1332 waiver applications that advance some or all of these five principles ... [1] Provide increased access to affordable private market coverage.... [2] Encourage sustainable spending growth.... [3] Foster state innovation.... [4] Support and empower those in need. Americans should have access to affordable, high value health insurance.... [5] Promote consumer-driven healthcare.... Consistent with [these] principles ... the Secretaries intend to provide states with maximum flexibility within the law to innovate, empower consumers, and expand higher value and more affordable coverage options."

Text of DOL Announcement: Listening Session Regarding Provider Nondiscrimination Under Section 2706(a) of the Public Health Service Act (PDF)

"[DOL, HHS and the Treasury Department] are hosting a listening session on January 19, 2022 regarding implementation of the provider nondiscrimination provision under section 2706(a) of the Public Health Service Act, which is incorporated by reference in section 715 of [ERISA] and section 9815 of the Internal Revenue Code. The listening session will be held virtually ... The purpose of the listening session is to foster an exchange of information and views and afford interested individuals and organizations an opportunity to share their perspective on what should be included in forthcoming proposed regulations."

EBSA, HHS and Treasury MHPAEA Guidance Compendium

"This document provides the citations to the MHPAEA Final and Interim Final Rules and the guidance the Departments have issued for each category of violation cited in DOL's and HHS's FY22 MHPAEA Enforcement Fact Sheet."

Text of Agency FAQs on ACA Implementation, Set 3: Exemption for Group Health Plans with Less Than Two Current Employees

Excerpt: [Here] are two Frequently Asked Questions (FAQs) regarding implementation of the market reform provisions of the Affordable Care Act. They have been prepared jointly by the Departments of Health and Human Services, Labor and the Treasury. Like the FAQs the Departments issued on September 20, 2010 and on October 8, 2010, these FAQs answer questions from stakeholders with a view to helping people understand the new law and benefit from it, as intended.

Text of Agency FAQs on ACA Implementation, Set 2: Grandfathered Health Plans, Dental and Vision Benefits, Rescissions, Preventive Health Services

Excerpt: Like the FAQs the Departments issued on September 20, 2010, these FAQs answer questions from stakeholders with a view to helping people understand the new law and benefit from it, as intended.