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HHS Releases Final Health Equity Rule under Section 1557 of the Affordable Care Act

On May 18, 2016, the Department of Health and Human Services (“HHS”) issued final regulations interpreting the nondiscrimination provisions of Section 1557 of the Affordable Care Act (“ACA”). The rule mainly impacts insurers and health care providers that receive federal subsidies from HHS. But certain self-insured employer sponsored group health plans are also subject to the rule, and may need to alter their plan designs to comply with the rule.

Final Rule Issued on ACA’s Non-Discrimination Provision for Federally Funded Programs

Section 1557 of the Affordable Care Act (“ACA”), in effect since 2010, prohibits discrimination in any federally funded health program on the basis of race, national origin, sex, age, or disability. The Department of Health and Human Services (“HHS”), through the Office of Civil Rights, has been enforcing the provision since it was enacted in 2010. HHS has now issued the Final Rule, “Nondiscrimination in Health Programs and Activities,” providing guidance to covered entities affected by the civil rights provision. The Final Rule requires certain covered entities to include specific nondiscrimination protections in their benefit plan design by the first day of the first plan year, beginning on or after January 1, 2017.

HHS Final Rule Finds Categorical Exclusions for Health Services Related to Gender Transition Are Generally Unlawful

The U.S. Department of Health and Human Services (HHS) recently published its Final Rule1 implementing Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of, among other grounds, sex in certain health programs and activities. According to HHS’s press release, the Final Rule and Section 1557 outline individuals’ rights, as well as the responsibilities of health insurers, hospitals, and health plans administered by or receiving federal funds, in order to advance protections for underserved, underinsured, and often excluded populations.

Healthcare Subsidies for Grad Students: An ACA Conundrum

Colleges and universities historically have provided graduate student employees (e.g., teaching assistants) with a stipend or reimbursement to help defray (or even fully cover) the cost of their medical coverage under the student health plan. Competing guidance from the Departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”) under the Affordable Care Act (“ACA”) will soon make such arrangements problematic.

"Off the Rails:" A Plan Administrator’s Burden

When an ERISA plan provides the plan administrator with discretion to interpret the terms of the plan, the administrator’s claims and appeals decisions are generally reviewed by courts under a lenient standard of review such as “abuse of discretion.” In such cases, courts generally will not upset the plan administrator’s decision absent a clear error.

Spokeo—New Hope for Defending Against ERISA Claims?

Last month, the Supreme Court of the United States issued its decision in Spokeo, Inc. v. Robins, No. 13–1339 (May 16, 2016). Spokeo involved a lawsuit brought under the Fair Credit Reporting Act of 1970 (FCRA). However, the Court’s opinion in Spokeo may create some new opportunities for defending against a broad range of claims under the Employee Retirement Income Security Act of 1974 (ERISA), including at least some types of fiduciary breach cases and perhaps even claims against plan administrators for a statutory penalty based on an alleged failure to provide copies of plan documents on request.

Arbitrator Slashes Annual Withdrawal Liability Payments in Underfunded Multiemployer Pension Plan Dispute

Employers who cease contributing to an ERISA multiemployer pension plan are liable for their allocable share of any underfunding, or “withdrawal liability.”

The Central States Rescue Plan Rejection and Next Steps

Like many other multiemployer pension plans, the Central States, Southeast and Southwest Areas Pension Fund was hit very hard by the financial crisis in 2008. In response, the Employee Retirement Income Security Act, or ERISA, was amended to allow Central States and other critically underfunded plans to remain solvent through the approval of a so-called “rescue plan.” On May 6, 2016, Central States’ proposed Rescue Plan was rejected by the IRS. This would have huge implications not just for the employers who contribute to the plan, but also for the Pension Benefit Guarantee Corporation (PBGC) and for participants and retires. Joining the WPI to examine the implications of the rejection of Central State’s plan was Littler shareholder Mike Congiu.

PBGC Issues Proposed Rule on Mergers and Transfers Between Multiemployer Plans

The Pension Benefit Guaranty Corporation (PBGC) recently released a proposed rule amending the agency’s regulations on mergers and transfers between multiemployer plans. The proposed rule would implement a section of the Multiemployer Pension Reform Act of 2014 (MPRA), which provides that the PBGC may offer assistance to multiemployer plans to facilitate plan mergers.

Benefits Update (No. 2, June 2016)

Many Affordable Care Act (ACA) requirements and deadlines are new and difficult to navigate. Below you will find information about Federally Facilitated Marketplace (FFM) Notices, which some employers may receive soon. Additionally, you will find below a reminder about approaching deadlines for health coverage reporting.