In a recent On the Subject (available here), we reported on the impact of the final rule (final rule) interpreting Section 1557 of the Affordable Care Act (ACA) on self-funded group health plans that contract with licensed health insurance issuers to provide administrative services. That article considered instances in which neither the plan sponsor nor […] The post The ACA 1557 Final Regulations: Plans and Plan Sponsors as Covered Entities appeared first on EMPLOYEE BENEFITS BLOG ..read more

A legislative fix to surprise medical billing is not working the way lawmakers imagined it would work. According to this Politico Pro article, private equity groups are disproportionately benefiting from the No Surprises Act, and the law may inadvertently lead to higher health insurance premiums. Access the article. The post Surprise Medical Billing Law ‘Not Working the Way We Want It to Work’ appeared first on EMPLOYEE BENEFITS BLOG ..read more

In recent years, states have been exploring innovative avenues to address rising healthcare costs and ensure access to affordable medication for their residents. One idea gaining traction involves pursuing authorization from the US Food and Drug Administration (FDA) for importation programs under Section 804 of the Federal Food, Drug, and Cosmetic Act (FDCA) to import […] The post Imported Drugs: (Possibly) Coming Soon to a State Near You appeared first on EMPLOYEE BENEFITS BLOG ..read more

The Centers for Medicare & Medicaid Services (CMS) announced in March that it would allow health plans under Medicare Part D (the Medicare prescription drug benefit) to cover Wegovy and other weight-loss medications if they receive Food and Drug Administration (FDA) approval for an additional medically accepted indication. In Wegovy’s case, the FDA recently approved an additional […] The post Medicare Coverage of Wegovy Raises Questions Regarding the Affordability and Accessibility of Novel Medications appeared first on EMPLOYEE BENEFITS BLOG ..read more

On March 18, 2024, the US Department of Health and Human Services Office for Civil Rights (OCR) issued an update to its December 1, 2022, bulletin titled “Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates.” In releasing the 2024 update, OCR stated that its purpose was to “increase clarity for regulated […] The post OCR Update on Tracking Technologies Provides Little Relief for HIPAA-Regulated Entities appeared first on EMPLOYEE BENEFITS BLOG ..read more

The Internal Revenue Service (IRS) recently announced (see Revenue Procedure 2024-25) cost-of-living adjustments to the applicable dollar limits for health savings accounts (HSAs), high-deductible health plans (HDHPs) and excepted benefit health reimbursement arrangements (HRAs) for 2025. All of the dollar limits currently in effect for 2024 will change for 2025, with the exception of one […] The post IRS Announces 2025 Limits for Health Savings Accounts, High-Deductible Health Plans and Excepted Benefit HRAs appeared first on EMPLOYEE BENEFITS BLOG ..read more

On April 10, 2024, the Centers for Medicare & Medicaid Services (CMS) posted the Hospital Inpatient Prospective Payment System (IPPS) proposed update for fiscal year (FY) 2025, along with proposed policy and regulation changes. The proposed rule would update Medicare payment policies and quality reporting programs relevant for inpatient hospital services, and build on key […] The post CMS Releases FY 2025 IPPS Proposed Update appeared first on EMPLOYEE BENEFITS BLOG ..read more

Congressional lawmakers must soon decide to continue or end payment changes for telehealth services enacted during the COVID-19 pandemic. However, according to this KFF Health News article, Congress will likely “kick the can” past the November election. Access the article. The post Congress Likely to Kick the Can on COVID-Era Telehealth Policies appeared first on EMPLOYEE BENEFITS BLOG ..read more

On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, otherwise known as the rate announcement. The rate announcement is released annually and includes updates to the methodologies used to calculate MA plan payments, […] The post 340B Remedy Rule and Medicare Advantage Rates: Navigating Shifting Payments appeared first on EMPLOYEE BENEFITS BLOG ..read more

On March 13, 2024, Indiana enacted Senate Bill No. 9, which establishes that the Office of the Indiana Attorney General must receive prior written notice of certain transactions involving Indiana healthcare entities. This new law goes into effect July 1, 2024, and has a more expansive reach than many of its peer transaction notice laws. […] The post Indiana Enacts New Law Requiring Notice of Healthcare Transactions appeared first on EMPLOYEE BENEFITS BLOG ..read more