Numerous states—including Florida, Texas and Michigan—have been busy finalizing telehealth-related rulemaking and legislation. Michigan’s proposed bills, for example, push for coverage parity across insurers and payment parity.
What else have these states been up to over the last month?
As of December 31, 2023, all employees physically working in Chicago for at least two hours in a two-week period will earn both one hour of paid leave and one hour of paid sick leave for every 35 hours worked, pursuant to an ordinance passed by the Chicago City Council on November 9, 2023. The new ordinance expands the current ordinance, which requires employers to provide only paid sick leave to employees.
On October 30, 2023, the Biden administration released a long-awaited Executive Order (EO) on the “Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence.” The EO acknowledges the transformative potential of AI while highlighting many known risks of AI tools and systems. It directs a broad range of actions around new standards for AI that will impact many sectors, and it articulates eight guiding principles and priorities to govern the development and use of AI.
This post continues our focus on comment letters submitted in response to proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). The proposed regulations were issued earlier this year by the US Departments of Labor, Health and Human Services and the Treasury (the Departments). Our previous MHPAEA content is available here.
The MHPAEA generally requires parity between mental health/substance use disorder (MH/SUD) benefits and medical/surgical (M/S) benefits with respect to annual and lifetime dollar limits, financial requirements and treatment limitations. Treatment limitations may be quantitative (quantitative treatment limitations or QTLs) or nonquantitative (nonquantitative treatment limitations or NQTLs). As the names suggest, QTLs involve limits to which numbers may be applied, e.g., cost-sharing amounts or length of a hospital stay, while NQTLs involved limitations that are not so restricted. The Consolidated Appropriations Act, 2021 added a requirement that plans and issuers perform and document comparative analyses of the design and application of NQTLs on MH/SUD and M/S benefits. The proposed regulations focus on the regulation of NQTLs and compliance with the comparative analyses requirement.
The proposed regulations establish a three-prong test that plans and issuers must pass to impose an NQTL in a classification. To qualify, an NQTL:
These requirements, if adopted as proposed, could make it difficult for group health plans to use third-party payers that manage their MH/SUD benefits under so-called “MH/SUD carve-out” vendor arrangements. Also referred to generically as “managed behavioral health organizations,” MH/SUD carve-out vendors are payers that claim specialized expertise with, and focus exclusively on the treatment of, mental health and substance use disorders. Plans contract with these providers for reasons of cost, quality and ease of administration. Even under current law, demonstrating compliance for a single NQTL involves a number of steps, each of which must be repeated for each additional NQTL. NQTLs designed and adopted by mainstream M/S providers and administrative services vendors and carve-out vendors will differ in their particulars. Layering on new, quantitative “no more restrictive” and “data collection” requirements will add a new level of complexity that may be prohibitively costly for plans that seek to use MH/SUD carve-out vendors.
Even if plans using MH/SUD carve-out vendors could manage to obtain and process all the required data, there is another concern: These entities typically design and adopt their own NQTLs that are presumably informed by their expertise adjudicating MH/SUD claims. These NQTLs will at least in some if not many instances bear little resemblance to the NQTLs adopted by a plan’s M/S benefit vendors, networks and payers. The proposed regulations include exceptions under which an NQTL applied to MH/SUD benefits [...]
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California Governor Gavin Newsom recently signed Assembly Bill 352 and Assembly Bill 254 into law, effective January 1, 2024. Through these new laws, California seeks to mitigate the risk of out-of-state prosecution of individuals seeking abortions or gender-affirming care. These bills include significant changes to California privacy and health information interoperability laws that will impact healthcare providers, health plans, employers, electronic health record developers and certain digital health companies handling medical information related to gender-affirming care, abortion, and abortion-related services, sexual health, fertility or contraception.
A Medicare program designed to incentivize high-quality care via physician bonuses is in doubt as providers say it’s caused more trouble than it’s worth. According to this Axios article, the Merit-Based Incentive Payment System has created a disparity between bonus winners and losers, and this disparity is only expected to grow.
Despite a two-year-old ban on surprise medical billing, insurers and providers are struggling to resolve unpaid claims. In this Axios article, McDermott+Consulting’s Jeffrey Davis offers perspective on the state of the claims resolution process.
As more telehealth providers offer weight-loss programs, they should be aware of the potential impact of state laws and regulations. In this blog post, we examine how Florida’s consumer protection laws affect these programs.
On October 4, 2023, California Governor Gavin Newsom signed Senate Bill 616 into law, officially expanding the Healthy Workplaces, Healthy Families Act of 2014, California’s paid sick leave law. Effective January 1, 2024, California employers must begin providing eligible employees with at least five days or 40 hours of paid sick leave, increased from the previous minimum of three days or 24 hours. Employers with combined paid time off policies should review and update their policies as needed.
Numerous states—including Alaska, Wisconsin, Ohio and Oregon—have been busy finalizing rulemaking and legislation advancing hybrid healthcare models, modernizing licensure infrastructures and incentivizing telehealth. What have these states been up to over the last month?
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