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The Impact of the ACA 1557 Final Regulations on Pregnancy and Abortion
By McDermott Will & Schulte on Jun 6, 2024
Posted In Employee Benefits, Health and Welfare Plans
Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability, or any combination thereof, in a health program or activity, any part of which is receiving federal financial assistance. On May 6, 2024, the US Department of Health and Human Services Office for...
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The Impact of the ACA 1557 Final Regulations on Gender-Affirming Care
By McDermott Will & Schulte on May 30, 2024
Posted In Employee Benefits, Health and Welfare Plans
Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability, or any combination thereof, in a health program or activity, any part of which is receiving federal financial assistance. On May 6, 2024, the US Department of Health and Human Services Office for...
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The ACA 1557 Final Regulations: Plans and Plan Sponsors as Covered Entities
By McDermott Will & Schulte on May 21, 2024
Posted In Employee Benefits, Health and Welfare Plans
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...
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Lessons from Ryan S. v. UnitedHealth Group for the 2023 MHPAEA Proposed Rule
By McDermott Will & Schulte on Apr 18, 2024
Posted In Employee Benefits, Health and Welfare Plans, Mental Health Parity and Addiction Equity Act
A recently decided US Court of Appeals for the Ninth Circuit case, Ryan S. v. UnitedHealth Group, Inc., offers some useful insights on the enforcement by private litigants of the Mental Health Parity and Addiction Equity Act (MHPAEA). Like other similar cases, the case invites questions about the impact of potential changes under the proposed...
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How Pending Fishing Boat Cases at the Supreme Court Could Rock the Benefits Plan Boat
By Wilber H. Boies, PC, Scott Kenkel, J. Christian Nemeth and McDermott Will & Schulte on Mar 12, 2024
Posted In Employee Benefits
If the US Supreme Court strikes down the established doctrine of significant judicial deference to certain government agency interpretations in two upcoming fishing boat cases, this decision could have ripple effects on employee benefit plan sponsors and fiduciaries. Such a decision would rock the boat and create more uncertainty in administering employee benefits. Read more...
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The MHPAEA Proposed Rule: ‘Meaningful Benefits’ and the ‘Scope of Services’
By McDermott Will & Schulte on Feb 20, 2024
Posted In Employee Benefits, Health and Welfare Plans, Mental Health Parity and Addiction Equity Act
This post continues our consideration of comments submitted in response to proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). Our previous MHPAEA content is available here. Under current law, if a plan provides any mental health or substance use disorder (MH/SUD) benefits in any classification of benefits, benefits for that condition or use disorder...
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The MHPAEA Proposed Rule: Standards of Care and Medical Necessity
By McDermott Will & Schulte on Feb 1, 2024
Posted In Employee Benefits, Health and Welfare Plans, Mental Health Parity and Addiction Equity Act
Comments submitted in response to the proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA) reflect a broad range of perspectives. Our previous MHPAEA content is available here. A nontrivial subset of the comments single out a particular nonqualified treatment limitation (NQTL) for special treatment or scrutiny. An example of this trend is...
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The MHPAEA Proposed Rule: Scalability and the Plight of the Small(er) Self-Funded Plan
By McDermott Will & Schulte on Jan 4, 2024
Posted In Employee Benefits, Health and Welfare Plans, Mental Health Parity and Addiction Equity Act
After a brief hiatus to discuss the pleading standards adopted by the US Court of Appeals for the Tenth Circuit in E.W. v. Health Net Life Insurance Company, we return to our examination of the comments submitted in response to the proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). The US...
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Parsing MHPAEA Claims Under the Proposed Rule: E.W. v. Health Net Life Insurance Company
By McDermott Will & Schulte on Dec 28, 2023
Posted In Employee Benefits, Mental Health Parity and Addiction Equity Act
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Funding Employer-Sponsored Group Health Coverage: The Group Captive Solution
By Lisa Kaderabek, Teal Trujillo and McDermott Will & Schulte on Dec 13, 2023
Posted In Employee Benefits, Health and Welfare Plans
The enactment of the Affordable Care Act in 2010 led to a sharp increase in employers self-funding their group health insurance plans, with the market tripling in size in the decade that followed. While larger employers can self-fund their group medical coverage in a relatively efficient manner, it does not work well for smaller employers....
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