Articles Discussing Health Care Reform.

Under the Affordable Care Act (ACA), applicable large employers (ALEs) — i.e., those with, on average, fifty (50) or more full-time or full-time-equivalent employees in the preceding year — must offer in the following year affordable, minimum value group health plan coverage to their full-time employees and those employees’ dependents

Employers, at least for now, may have some relief from some of the Affordable Care Act (ACA) requirements to cover preventive care services without cost sharing under a nationwide injunction issued March 30, 2023, by a federal judge in Texas.

The Consolidated Appropriations Act, 2023 (CAA 2023) holds some welcome news for employers that offer a high deductible health plan (HDHP) option paired with a health savings account (HSA).

The Consolidated Appropriations Act (CAA) adopted a new prescription drug reporting mandate on November 12, 2021. The mandate requires group health plans and group health insurers to submit prescription drug and health care spending reports to the Department of Labor, the Department of Health and Human Services, and the Internal Revenue Service (“the agencies”) on annual basis. Under the CAA, the following information must be reported to the agencies by December 27, 2022:

The Patient-Centered Outcomes Research Institute (“PCORI”) is an independent nonprofit research organization that funds comparative clinical research, among other things.  PCORI is funded through annual fees — provided for in the Affordable Care Act — paid by insurers of fully-insured health plans and sponsors of self-insured health plans, including health

In 2020, the Centers for Medicare & Medicaid Services (CMS) released the Transparency in Coverage Final Rules (TiC Final Rules) which, among other things, require non-grandfathered group health plans to post on a public website certain plan pricing information in machine-readable files (MRFs) by July 1, 2022.

The Supreme Court of the United States, on April 28, 2022, held that emotional distress damages are not available for private discrimination claims under the federal Rehabilitation Act of 1973 and the Affordable Care Act (ACA).

The U.S. Supreme Court ruled that emotional distress damages are not recoverable in private actions to enforce statutes authorized by the Spending Clause of the U.S. Constitution. Cummings v. Premier Rehab Keller, P.L.L.C., No. 20-219 (Apr. 28, 2022).

On April 19, 2022, the Departments of Labor, Health and Human Services, and the Treasury issued additional guidance under the Transparency in Coverage Final Rules issued in 2020.  The guidance, FAQs About Affordable Care Act Implementation Part 53, provides a safe harbor for disclosing in-network healthcare costs that cannot be

The IRS just released IRS Notice 2022-04 that provides the updated fee for Patient-Centered Outcomes Research Institute (PCORI) paid by fully insured and self-funded health plans for the upcoming tax reporting period.

As we stated before, even though the original PCORI fee assessments under the Affordable Care Act were scheduled

Just three weeks ago, we wrote that employers likely would not receive certain Affordable Care Act reporting relief to which they’ve become accustomed.

But in a welcome turn of events, the IRS just released proposed regulations that make permanent a 30-day automatic extension for furnishing Forms 1095-B and 1095-C to

News Flash:  There’s no actual statutory mandate that employers offer group health coverage at all, much less coverage for specific conditions.  However, federal law requires health plans that provide mental health and substance use disorder coverage to ensure that the financial requirements (like coinsurance) and treatment limitations (like visit limits

As employers with 50 or more full-time (or full-time equivalent) employees are well aware, the Patient Protection and Affordable Care Act (”ACA”) requires annual submission of Forms 1094-C and 1095-C with the Internal Revenue Service, and distribution of Forms 1095-C.  These submissions and distributions are generally due:

 Furnishing of Forms

Plan participants can be hit with surprise medical bills when they receive care from out-of-network providers. Sometimes, this happens when participants do not know that the care they are receiving is from an out-of-network provider, like when they have surgery at an in-network facility only to find that the facility-appointed

This term, the U.S. Supreme Court returns to a challenge to the Affordable Care Act (ACA). In the consolidated cases of California v. Texas (No. 19-840) and Texas v. California (No. 19-1019), the Court will consider whether a group of states and private individuals have standing to challenge the ACA. If that procedural