Section 1557 of the Affordable Care Act prohibits discrimination in healthcare based on a number of characteristics including race, color, national origin, sex, age, and disability. On April 26, 2024, the Department of Health and Human Services (HHS) issued a Final Rule that according to HHS provides clarity on Section 1557 with a goal of ensuring nondiscriminatory access to care for all, including women, people with disabilities, LGBTQI+ people, people with limited English proficiency (LEP), people of color, and people regardless of age. The first Section 1557 final rule was published in 2016 followed by a second final rule in 2020 that rescinded large sections of the 2016 rule. The 2024 Final Rule restores those provisions and enhances them.Continue Reading Nondiscrimination in Healthcare: HHS’s New Final Rule Under Section 1557 of the Affordable Care Act

If you track national health care policy developments, you’ve been busy lately.

Following weeks of growing declarations from Democrats in support of Medicare for All, US House Speaker Nancy Pelosi tamped down exuberance over any plans to replace the Affordable Care Act (ACA).  Then the US Justice Department spoke up.

In a March 25 statement to the Court of Appeals for the Fifth Circuit, Justice Department lawyers said US District Court Judge Reed O’Connor’s ruling should be affirmed—that the entire ACA coverage mandate is unconstitutional, and since the provision is inseverable from the ACA, the entire Act is invalid.  The ACA remains in place as the District Court ruling is under appeal.
Continue Reading Medicare for All, Part 2: Cost, Financing and Impact on Provider Payment

One conclusion drawn from the 2018 midterm elections is health care is a big deal for Americans. In fact, according to pre- and post-election polling, health care may be the biggest deal, as a plurality of voters identified health care as their top issue in casting their vote.  
Continue Reading Health Care Drives Voters at the Polls, but Will Health Care Drive Policymaking?

A new rule proposed by the Centers for Medicare and Medicaid Services (CMS) on October 26, 2018, would revise the way the agency validates the risk adjustment data and collects repayments from Medicare Advantage (MA) organizations. With the new methodology, CMS is expecting to return $4.5 billion in savings to the Medicare Trust Fund over 10 years, according to an October 26 CMS news release.
Continue Reading CMS Issues Proposed Rule Addressing Payment Error in Medicare Advantage, Expects to Recover $4.5 Billion Over 10 Years

Anticipating open enrollment season for coverage in 2019, the Centers for Medicare and Medicaid Services (CMS) released coverage and premium information that will factor into consumer decisions about Medicare and individual commercial plans offered through exchanges. Enrollment and premium trends also inform regulatory and broader policy decisions at both federal and state levels.
Continue Reading Open Enrollment Update: CMS Releases Benefit and Market Data

A federal court decision to vacate regulations concerning “overpayments” to Medicare Advantage plans has left open questions about the way the government pays the insurers and pending cases brought by the U.S. Department of Justice.
Continue Reading Court Decision on Overpayment Rule Leaves Uncertain Future for Medicare Payment Methodology and Pending Justice Department Lawsuits

This is the third article in our series on Association Health Plans (AHP). This week’s discussion focuses on the mixed reaction to the recent Department of Labor (DOL) AHP.

In the health benefits market, some state-based associations, such as Wisconsin’s largest business association, have announced their intent to create an AHP. On the other hand, the National Federation of Independent Business (NFIB), a long-time advocate of AHPs, is declining to establish an AHP because the rule falls short of what the NFIB felt was needed to establish an AHP, according to reports.  
Continue Reading Association Health Plans Are Drawing A Lot of Attention, Including Some Pushback

This is the second article in our series on Association Health Plans (AHP). This week’s discussion focuses on the potential impact of the Department of Labor’s (DOL) decision to relax some AHP requirements.

The U.S. Department of Labor (DOL) recently expanded the ability of small groups and the self-employed to obtain health coverage through AHPs. A final rule published June 21 eases certain AHP requirements and restrictions.
Continue Reading DOL Rule Relaxes Some AHP Requirements, Points to Other Protections

A new federal rule gives small employers and the self-employed an additional avenue for obtaining group health coverage.

The final rule, released by the U.S. Department of Labor (DOL) June 19 and published June 21, broadens the definition of “employer” for purposes of determining who can establish multiple employer group health plans under section 3(5) of the Employee Retirement Income Security Act of 1974 (ERISA).
Continue Reading New Labor Department Rule Expands Group Health Coverage Option

On October 17, 2017, the IRS announced that it will not accept electronically filed tax returns for the year 2017 (to be filed in 2018) that fail to address the health coverage requirements of the Affordable Care Act (“ACA”). The “IRS Statement on Health Care Reporting Requirement” notes that “‎[t]axpayers remain obligated to follow the law and pay what they may owe at the point of filing‎. The 2018 filing season will be the first time the IRS will not accept tax returns that omit this information.” The prior guidance called into question whether the IRS would enforce the individual mandate provisions of the ACA. The new guidance makes clear that it will do so.
Continue Reading IRS Issues New Statement Regarding Health Care Reporting Requirements