Health and Welfare Plans Archives - Page 20 of 129

HHS Announces Record Number of ACA Marketplace Enrollments

by Debra Curtis, Kristen O'Brien and Erica Stocker | Feb 23, 2023 | Employee Benefits, Health and Welfare Plans

On January 25, 2023, the US Department of Health and Human Services (HHS) announced that more than 16.3 million people nationwide selected an ACA Marketplace health plan during the 2023 open enrollment period that ran from November 1, 2022, until January 15, 2023, for most marketplaces.

According to HHS, total plan selections include 3.6 million people who are new to the marketplaces for 2023 (22% of the total). The 3.6 million figure is a 21% increase in new-to-marketplace plan selections over last year.

The data included in HHS’s January 25 announcement represents activity through January 15 for the 33 marketplaces using HealthCare.gov, and through January 14 or 15 for the 18 state-based marketplaces in 17 states and the District of Columbia that use their own eligibility and enrollment platforms. Some state-based marketplaces are still in open enrollment and will report updated enrollment data after that period closes. A fact sheet on state-based marketplace open enrollment deadlines can be found here.

CMS Issues Broad-Ranging Medicare Advantage and Part D Proposed Rule

by Ankur J. Goel, Emily Curran, Grayson I. Dimick and Casey Li | Feb 21, 2023 | Employee Benefits, Health and Welfare Plans

The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule regarding Contract Year 2024 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs. This proposed rule includes a range of proposals addressing popular topics, including marketing and prior authorization, along with other significant changes to utilization management, Quality Star Ratings and the Programs of All-Inclusive Care for the Elderly (PACE).

Read more here.

Doctor-Patient Relationships and Medical Marijuana: Where Are We Now?

by Brian Malkin | Feb 15, 2023 | Employee Benefits, Health and Welfare Plans

Recently, President Joe Biden signed the Medical Marijuana and Cannabidiol Research Expansion Act, which provides a mechanism for industry and academia to access and research cannabis (including marijuana and other cannabis-derived products) without violating the Controlled Substances Act. This legislation creates a pathway for researchers to register with the US Department of Justice to legally conduct scientific research on such products subject to certain requirements. It also creates a system to allow drug manufacturers to legally produce products approved by the US Food and Drug Administration that contain cannabidiol or marijuana for commercial sale. The legislation also includes a doctor-patient relationship provision that permits state-licensed physicians to discuss the “currently known potential harms and benefits of marijuana and its derivatives, including cannabidiol, which may be derived from marijuana or other cannabis products such as hemp, as a treatment,” which may be of significant interest for healthcare providers.

Read more here.

Proposed Universal Contraceptive Coverage in Response to Roe Reversal

by Alden Bianchi and Sarah Raaii | Feb 14, 2023 | Employee Benefits, Health and Welfare Plans

The US Departments of Health and Human Services, Labor and Treasury (the Departments) recently issued a proposed rule to eliminate a moral exemption to the Affordable Care Act (ACA) contraceptive mandate and establish an “individual contraceptive arrangement” to permit individuals to obtain contraceptive services at no cost in instances in which their employer does not offer coverage based on its religious beliefs. This is the latest development in the Biden administration’s efforts to increase reproductive health access after Dobbs v. Jackson Women’s Health Organization. The Departments previously issued a reminder to health plans and insurers that the ACA requires contraceptive coverage at no additional cost to individuals.

Read more here.

No Surprises Act and Three Takeaways on Surprise Billing

by Alden Bianchi and Sarah Raaii | Feb 8, 2023 | Employee Benefits, Health and Welfare Plans

The No Surprises Act (NSA) provides federal protections against surprise billing with respect to emergency services, non-emergency items or services furnished by out-of-network providers at certain in-network healthcare facilities, and air ambulance services furnished by out-of-network providers of air ambulance services. The NSA also establishes that certain federal agencies publish information quarterly about the Federal IDR process. The first such report, Initial Report on the Independent Dispute Resolution (IDR) Process April 15 – September 30, 2022, offers insight into dispute volume, interaction of the Federal IDR process with the claims procedure rules and problems with botched claims.

Read more here.

Amid Dwindling COVID Relief Funds, Rural Hospitals Face a ‘Fiscal Cliff’

by Emily J. Cook | Jan 31, 2023 | Employee Benefits, Health and Welfare Plans

What do healthcare leaders predict is next for rural hospitals? In this Fierce Healthcare article, McDermott Partner Emily Jane Cook offers her perspective about rural emergency hospitals and possible legislative action around them.

Access the article.

Drug Discount Review Boards Proposed by Biden Health Agency

by Emily J. Cook | Jan 26, 2023 | Digital Health, Health and Welfare Plans

The Biden administration recently proposed revising the process behind an outlet for pharmaceutical companies to resolve price fights for those participating in the 340B drug discount program. According to this Bloomberg article, disputes between providers and pharmaceutical companies were in limbo as the industry waited for the Biden administration to replace an administrative dispute resolution (ADR) board. McDermott Partner Emily J. Cook said the proposed US Department of Health and Human Services rule ushers in “some significant changes” from the prior ADR process.

Access the full article.

Healthcare Predictions for 2023: Hard Choices and Working Smarter

by Kerrin B. Slattery | Jan 25, 2023 | Employee Benefits, Health and Welfare Plans

What is the primary force that will act on healthcare in 2023? What topics, trends and opportunities are hot this year? And how does the public feel about healthcare provider organizations today?

In this special report produced by Jarrad Inc., McDermott Partner Kerrin B. Slattery and other industry professionals provide insight into the themes that will shape the healthcare industry this year.

Read more here.

Major Changes Proposed to Substance Use Disorder Confidentiality Law

by Scott Weinstein, Edward G. Zacharias, Abby Higgins and Li Wang | Jan 24, 2023 | Employee Benefits, Health and Welfare Plans

In a Notice of Proposed Rulemaking published December 2, 2022 (the Proposed Rule), the United States Department of Health and Human Services (HHS) proposed long-awaited changes to the regulations protecting the confidentiality of substance use disorder patient records under Part 2 of Title 42 of the Code of Federal Regulations (42 CFR Part 2, or Part 2). Specifically, the Proposed Rule would implement provisions of Section 3221 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which required HHS to align Part 2 with certain provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and to make certain changes to the HIPAA Notice of Privacy Practices, the form given to patients and plan members that describes patient privacy rights, covered entity duties, and the covered entity’s uses and disclosures of protected health information (PHI).

Read more here.

Pandemic Response Accountability Committee Report Highlights Telehealth Program Integrity Concerns

by James A. Cannatti III, Tony Maida, Lester Perling and Dexter Golinghorst | Jan 18, 2023 | Digital Health, Employee Benefits, Health and Welfare Plans

On December 1, 2022, the Pandemic Response Accountability Committee (PRAC) Health Care Subgroup issued its report on fraud, waste and abuse risks that arose as a result of the dramatic increase in telehealth services provided during the COVID-19 pandemic. The PRAC was created under the CARES Act to oversee the historic spending that was part of the federal government’s response to the COVID-19 pandemic. The PRAC Health Care Subgroup comprises the offices of the inspector general (OIGs) for six federal agencies:

The US Department of Health and Human Services (HHS)
The US Department of Defense (DoD)
The Office of Personnel Management (OPM)
The US Department of Veterans Affairs (VA)
The US Department of Labor (DOL)
The US Department of Justice (DOJ).

Each OIG oversees an agency that administers a federal program connected to using or paying for telehealth services.

The report highlights the increased access to services that telehealth facilitated during the pandemic and notes key focus areas with respect to program integrity and preventing fraud and abuse. The report is a resource intended to be used by stakeholders across the healthcare industry, including congressional lawmakers, federal and state agencies, and healthcare organizations. The report aims to raise awareness of the importance of safeguarding expanded telehealth services against fraud, waste and abuse.

Read more here.

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