Benefits News Brief: 7/22

  • In late June, a federal district court (the Court) ruled that a health insurer that provided coverage for Medicare and Medicaid recipients must comply with ACA Section 1557 Nondiscrimination Rules for its entire portfolio of business, including its private insurance products. Applying the Chevron analysis, the Court ruled that the statute clearly applied the nondiscrimination requirement to an insurer’s entire portfolio of business (even if it just receives federal financial assistance for a portion of it). For this reason, the Trump-era regulations that narrowed the scope of Section 1557’s applicability did not control the Court’s analysis.
  • On July 1, 2021, The Office of Personnel Management (OPM), along with the departments of Health and Human Services (HHS), Labor (DOL), and Treasury released “Part 1” of regulations implementing the No Surprises Act.  (The regulations were published in the Federal Register on July 13.) The interim final rule with comment period (IFC) addresses several provisions in the law, including the ban on balance billing for certain out-of-network services (referred to as “surprise medical bills”); the notice and consent process that some providers may use to bill patients for out-of-network services; how patient cost-sharing must be calculated; and a complaint process for any potential violations of the provisions in the law. For more details, see our employer communication here.
  • On July 19, the DOL, HHS, and the Treasury (“the Departments”) issued new Affordable Care Act (ACA) FAQs clarifying the coverage requirements under the ACA’s preventive services mandate for pre-exposure prophylaxis (PrEP) and related services. The Departments have implemented a limited non-enforcement period to give plans that may have misunderstood the scope of the USPSTF recommendation time to come into compliance. The FAQs also address the circumstances under which plans and issuers may use reasonable medical management techniques with respect to coverage of PrEP and related services.
  • Also on July 19, HHS renewed the Covid-19 public health emergency declaration, effective July 20, 2021, for another 90 days.
  • Another reminder that PCORI fees are due July 31st. For more information on this requirements, see our employer communications here and here.