C&M Health Law

C&M Health Law

Analysis, commentary, and the latest developments in health care law and policy

David Didier Johnson

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New Mental Health Parity Guidance on NQTL Disclosures May Signal Enforcement Priorities

Posted in Mental Health Parity
The regulators for the Mental Health Parity and Addiction Equity Act (MHPAEA) have just issued guidance on health plan disclosures for non-quantitative treatment limitations (NQTLs).  This guidance consists of an FAQ and a proposed model form for plan members to request information so they can determine whether their plan’s NQTLs are at parity. The regulations… Continue Reading

Waiting for the Supremes: High Court’s Decision in Gloucester County to Determine Validity of ACA Section 1557 Gender Identity and Transgender Services Rules

Posted in Exchanges, Health Care Reform & ACA
Two district courts[1] have recently stayed cases alleging that sex discrimination under ACA Section 1557 includes discrimination on the basis of gender identity and denial of coverage for gender transition, pending the Supreme Court’s decision in G.G. v. Gloucester County School Board.[2]  The Supreme Court accepted certiorari in Gloucester in October 2016 to determine the… Continue Reading

District Court Issues Nationwide Injunction on ACA 1557 Regulations on Gender Identity and Abortion

Posted in Administrative Law
On December 31, 2016, in Franciscan Alliance v. Burwell, Case No. 7:16-cv-00108-O, the District Court for the Northern District of Texas  issued a nationwide injunction finding that portions of the U.S. Department of Health & Human Services, Office for Civil Right’s (OCR) Final Rule for ACA Section 1557 violated the Administrative Procedures Act and cannot… Continue Reading

HHS Announces Final Rule for Section 1557 – The ACA’s Broad Anti-Discrimination Rule

Posted in Health Care Reform & ACA
Today HHS published its Final Rule for ACA Section 1557 in the Federal Register. A summary of the Final Rule and fact sheets on specific provisions are available here. The Final Rule contains some important new changes from the Proposed Rule which was published last Fall. We will issue a more comprehensive client alert shortly.… Continue Reading

CMS Issues Proposed 2017 Benefit and Payment Parameters Rule

Posted in Health Care Reform & ACA
On December 2, 2015, CMS will publish a notice of proposed rulemaking for its Notice of Benefit and Payment Parameters for 2017 (“Proposed Rule”). The Proposed Rule articulates the federal government’s policy for health care coverage under Affordable Care Act programs and would make several notable changes, including stricter network adequacy requirements for qualified health plans offering… Continue Reading

New California Court of Appeal Decision May Impose Premium Taxes on California Health Plans

Posted in Litigation
Since their inception, California health care service plans have been considered not to be insurers for purposes of the State’s 2.35 percent gross premium tax. Under a controversial ruling issued by the Court of Appeal, this could change. On September 25, the Court of Appeal held that a suit alleging that California’s Blue Shield and… Continue Reading

CMS Proposed Rule Implements Mental-Health Parity Requirements for Medicaid Managed Care and CHIP Plans

Posted in Medicaid, Mental Health Parity
On April 6, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule to implement the 2008 Mental Health Parity and Addiction Equity Act (“MHPAEA”) for coverage offered by Medicaid Managed Care Organizations (“MCOs”), Medicaid Alternative Benefit Plans (“ABPs”) and the Children’s Health Insurance Program (“CHIP”).  MHPAEA requires group health plans and health… Continue Reading

The Obama Administration’s ‘Fix’ for Insurance Cancellations: Five Things Worth Taking into Account

Posted in Exchanges, Health Care Reform & ACA
President Obama announced on November 14 that the Administration will allow health insurers to continue certain coverage in the individual and small group market which would have not otherwise met the market reform requirements of the Affordable Care Act (ACA). This change raises significant questions and operational problems for issuers, providers, employer sponsors of health plans,… Continue Reading

Final Mental Health Parity Regulations Issued

Posted in Mental Health Parity
On Friday, November 8, the the Departments of Labor, Treasury and Health and Human Services (collectively, the “Departments”) issued final regulations under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). (The rules are scheduled to be published in the Federal Register on November 13, 2013.) The final… Continue Reading