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What’s Old Is New Again: HHS Proposes to Reinstate and Expand Transgender Nondiscrimination Rules

Since it was enacted in 2010, Section 1557 of the Affordable Care Act (“Section 1557”) has prohibited discrimination in covered health programs and activities on the basis of race, color, national origin, age, disability, or sex.  As we have previously reported, the application of Section 1557 has proven controversial with several competing regulations and numerous […]

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Federal Agencies Issue Guidance After Dobbs Ruling

In response to the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, the U.S. Department of Health and Human Services (“HHS”) Secretary Xavier Becerra directed HHS agencies to act within their power to protect the rights of patients seeking reproductive care and their providers.  Some of the significant guidance HHS agencies issued in […]

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Must Drug Manufacturer Coupons Count Toward Annual Maximum Out-Of-Pocket Limits? Stay Tuned …

What is the Annual Maximum Out-Of-Pocket Limit (“MOOP”)? MOOP is the most a participant must pay for covered services under a group health plan in a plan year. After a participant spends this amount on deductibles, copayments, and coinsurance, the health plan must pay 100% of the costs of covered benefits. What are Drug Manufacturers’ […]

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Reassigning Section 1557: Trump Administration Proposes Reversal of Transgender Benefits Rule

In 2016, the Department of Health and Human Services (“HHS”) Office of Civil Rights issued final regulations implementing the nondiscrimination provisions of the Affordable Care Act (“Section 1557”), which prohibit the categorical refusal of health coverage to transgender participants and require that individuals be treated consistent with their self-selected gender identity. These regulations drew sustained […]

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RJ
Former Associate

HHS to Start Randomly Selecting Health Plans for HIPAA Compliance – Are You Ready?

The CMS Division of National Standards, on behalf of HHS, is launching the Compliance Review Program (the “Program”) to ensure compliance among covered entities with HIPAA Administrative Simplification rules for electronic health care transactions.  HHS will randomly select health plans and clearinghouses to assess compliance with: (1) transaction formats; (2) code sets; and (3) unique […]

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Transgender Benefits Revisited?

In a series of tweets published on July 26, 2017, President Trump announced a ban on transgender service in the armed forces.  In the wake of this reversal of government policy, employers may question the current state of transgender benefits and whether additional changes are forthcoming. On May 18, 2016, the Department of Health and […]

2017 HIPAA Enforcement – Appears Not To Be Slowing Down

To state the obvious, there has been some uncertainty regarding how the Trump Administration will affect federal agency enforcement efforts.  However, at least, in regard to HIPAA Privacy and Security, the U.S. Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”), appears to be unchanging in its previous course. In the first […]

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Trumping the Affordable Care Act? Not So Fast – Impact of Executive Order on Employers Unclear

On January 20, 2017, President Trump signed an Executive Order (“Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” hereinafter referred to as the “Order”) relating to the future of the Affordable Care Act (“ACA”).  The stated goal is to direct the agencies (IRS, HHS, and DOL) to waive or […]

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KP
Former Associate

A Deeper Dive: Employers Receiving Federal Funding May Be Subject to ACA’s Nondiscrimination Rule and Need to Cover Transgender Benefits

In recent months, we have written a fair amount about providing transgender benefits in light of the nondiscrimination provisions of the Affordable Care Act. Our blogs of March 30, 2016 and June 22, 2016 highlight the key contours of the nondiscrimination rule.  In our June 22 post, we mention in passing that the final nondiscrimination […]

You Received a Health Insurance Marketplace Notice from HHS – Now What?

Take a deep breath.  The HHS Health Insurance Marketplace Notice (the “Notice”) may seem to be a nuisance, but it does not necessarily mean that you will be subject to employer shared responsibility penalties. First, the IRS, not HHS, assesses employer shared responsibility penalties, and the IRS does so only after it provides employers with: […]