Click here for a printer-friendly version. State legislatures have increasingly regulated Pharmacy Benefit Managers (PBMs) in the wake of Rutledge v. Pharmaceutical Care Management Association,Rutledge v. Pharmaceutical Care Management Ass’n, 592 U.S. 80 (2020). a 2020 Supreme Court [...]
Click here for a printer-friendly version. A federal district court in Texas previously ruled that the United States Preventive Services Task Force (USPSTF) lacked authority to determine which services are covered by the Affordable Care Act’s preventive care mandate, [...]
Click here for a printer-friendly version. In recent years, Congress and federal agencies have pushed for greater transparency into the cost of healthcare through the passage of the 2021 Consolidated Appropriations Act and Transparency in Coverage rules.Consolidated Appropriations Act, [...]
In the last several years, courts have grappled with ERISA plan terms that require participants to arbitrate their claims on an individual basis. Recently, the 10th Circuit invalidated a plan’s arbitration term in Harrison v. Envision Management Holding because it would have restricted the statutory ERISA remedies participants were otherwise entitled to seek.
In June, the Supreme Court ruled the Constitution does not guarantee a right to abortion, leaving states free to regulate them. This means state law may dictate coverage of abortions by insured health plans while ERISA plan sponsors may decide whether self-funded health plans will cover abortions. Limits on coverage will apply—for example, plans generally will not cover medical procedures that are illegal in the state where performed. Other issues remain open—for example, coverage of abortifacient drugs obtained out-of-state and reimbursement for out-of-state travel to obtain an abortion. Upcoming legislative sessions will likely produce additional laws.
Click here for a printer-friendly version. Various regulations and guidance from the HHS, DOL, and the Department of Treasury (the Departments) address implementation of the surprise billing rules and transparency regulations under the Consolidated Appropriation Act, 2021 (CAA), which [...]
On August 20, 2021, the Departments of Labor, Health and Human Services, and the Treasury (collectively, “the Departments”) issued a series of FAQs on certain surprise billing and transparency provisions of the Consolidated Appropriations Act, 2021 [...]
Congress and agencies issued various relief and rules in response to the COVID-19 pandemic: The Families First Coronavirus Response Act temporarily requires group health plans to cover COVID-19 testing and related services without cost-sharing. The Coronavirus Aid, [...]
In December 2019, the Fifth Circuit Court of AppealsTexas v. United States, 945 F.3d 355 (5th Cir. 2019), as revised (Dec. 20, 2019). struck down the individual mandate penalty under the Affordable Care Act (ACA) for an individual [...]