C&M Health Law

C&M Health Law

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

Category Archives: ERISA

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$33 Million Settlement Approved For Systematic and Improper “Bundling” of Chiropractic CPT Codes

Posted in ERISA, Managed Care Lawsuit Watch
In what appears to be one of the largest class action settlement in the history of ERISA litigation in New Jersey, a federal judge approved $33 million settlement, including $11 million in attorneys’ fees, between Horizon Healthcare Services, Inc. (“Horizon”) and plaintiff chiropractors. The underlying lawsuit stemmed from allegations that Horizon made “across-the-board” denials of… Continue Reading

DOL, HHS & Treasury Issue Guidance on Cost Sharing and Provider Non-Discrimination Under ACA

Posted in Employee Benefits, ERISA, Health Care Reform & ACA
On May 26, the Departments of Health and Human Services (“HHS”), Labor (“DOL”) and Treasury (collectively, the “Departments”) issued Part XXVII of their FAQs about Affordable Care Act implementation. This latest FAQ provides additional guidance regarding limitations on cost sharing under the ACA, as well as further information and guidance regarding the ACA’s “provider non-discrimination”… Continue Reading

DOL, HHS & Treasury Issue Guidance on Contraceptives and Other Preventive Services under ACA

Posted in Employee Benefits, ERISA, Health Care Reform & ACA
On May 11, the Departments of Health and Human Services (HHS), Labor (DOL) and Treasury (collectively, the “Departments”) issued Part XXVI of their FAQs about Affordable Care Act implementation. This latest FAQ provides additional guidance regarding “first-dollar” coverage of preventive services under the ACA (i.e., the requirement to provide certain preventive services without the imposition… Continue Reading

Proposed EEOC Rules Promise to Bring Some Harmony to Wellness Plan Compliance Efforts

Posted in Employee Benefits, ERISA
Ensuring that wellness plans are legally compliant has been challenging in recent years, with the Equal Employment Opportunity Commission challenging as unlawful certain wellness plan features expressly permitted by the Departments of Labor, Health and Human Services and Treasury (the “Departments”). However, proposed EEOC regulations on the use of incentives under wellness plans promise to… Continue Reading

IRS Provides First Guidance on ACA’s ‘Cadillac Tax’

Posted in Employee Benefits, ERISA, Health Care Reform & ACA
On February 23, the Department of Treasury and the Internal Revenue Service (collectively, the “Agencies”) issued Notice 2015-16, the first piece of guidance on the Affordable Care Act’s “Cadillac Tax.” The Cadillac Tax is a 40 percent excise tax that is imposed on high-cost health plans under Section 4980I of the Internal Revenue Code (Code),… Continue Reading

DOL, HHS & Treasury Issue Additional Guidance Regarding Excepted Benefits

Posted in Employee Benefits, ERISA, Health Care Reform & ACA, HIPAA & Privacy, Mental Health Parity
On February 13, the Departments of Health and Human Services (“HHS”), Labor (“DOL”) and Treasury (collectively, the “Departments”) issued Part XXIII of their FAQs about Affordable Care Act implementation. This latest FAQ provides additional guidance regarding “excepted benefits,” i.e., benefits that are exempt from the portability rules under HIPAA as well as various requirements under… Continue Reading

What Corporate Counsel Need to Know in 2015 – Litigation and Regulatory Forecasts from Crowell & Moring

Posted in ERISA, Health Care Reform & ACA, HIPAA & Privacy, Litigation, Medicaid, Medical Loss Ratios, Medicare
Crowell & Moring’s 2015 Litigation and Regulatory Forecasts provide an in-depth look at the trends in the courts and in the regulatory agencies, both inside the Beltway and beyond, that will impact business in the coming year. The Litigation Forecast examines the latest litigation developments facing companies in areas ranging from health care and antitrust… Continue Reading

HHS, Labor, and Treasury Issue Proposed Amendments to “Excepted Benefit” Rules

Posted in ERISA, Health Care Reform & ACA, Mental Health Parity
On October 1, 2014, the Departments of Health and Human Services (“HHS”), Labor (“DOL”) and Treasury (collectively, the “Departments”) published regulations finalizing a proposed amendment to the “excepted benefit” rules, i.e., the rules that govern when certain types of benefits are exempt from HIPAA’s portability rules as well as various requirements under ERISA (including applicability… Continue Reading

90-Day Waiting Period for Employee Enrollment in Group Health Plans: One-Month Orientation Period Permitted

Posted in ERISA, Health Care Reform & ACA
On June 25, the Internal Revenue Service, Centers for Medicare & Medicaid Services, and Employee Benefits Security Administration, published final regulations clarifying the maximum allowed length of a reasonable and bona fide employment-based orientation period. Specifically, the regulations permit employers to impose a one-month orientation period on employees’ enrollment in their group health plans in… Continue Reading

COBRA, Cost-Sharing, and Other Matters Clarified in the Affordable Care Act’s Nineteenth Set of FAQs

Posted in ERISA, Exchanges, Health Care Reform & ACA
On May 2, 2014, the Internal Revenue Service, Department of Health and Human Services, and Department of Labor (the “Departments”) collectively released the Affordable Care Act’s (ACA) nineteenth set of Frequently Asked Questions (FAQs). The FAQ addressed outstanding questions regarding Health Care Continuation Coverage (COBRA) and Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)… Continue Reading

HHS Issues Proposed Notice of Benefit and Payment Parameters for 2015; Includes Carve-out for Certain Self-insured, Self-administered Plans

Posted in ERISA, Exchanges, Health Care Reform & ACA
On November 25, 2013, the Department of Health and Human Services (HHS) released a Proposed Notice of Benefit and Payment Parameters for 2015 regarding the Affordable Care Act’s Transitional Reinsurance Program (TRP) fee. The Proposed Notice includes the previously announced carve-outs from the TRP fee for the 2015 and 2016 years for certain self-insured, “self-administered”… Continue Reading

Final Rule on Coverage of Preventive Health Services Issued

Posted in ERISA, Exchanges, Health Care Reform & ACA
On July 2, 2013, the Department of Health and Human Services (HHS) issued a final rule on coverage of certain preventive services under section 2713 of the Public Health Service Act, added by the Patient Protection and Affordable Care Act and incorporated into the Employment Retirement Income Security Act of 1975 and the Internal Revenue… Continue Reading