Proposed Regulations Issued to Substantially Increase Access to Federally Subsidized Health Insurance

Jennifer Berman, CEO, MZQ Consulting On April 5, 2022, the Administration issued new proposed regulations changing certain aspects of the affordability and minimum value rules under the Affordable Care Act (“ACA”).  Notably, the rules only impact whether an individual is eligible for federally subsidized health insurance; they DO NOT change the affordability requirements for applicableContinue reading “Proposed Regulations Issued to Substantially Increase Access to Federally Subsidized Health Insurance”

CAA of 2022 Includes Federal Extension to Telehealth Protections for HDHPs

By: Jessica Waltman, Principal, Forward Health Consulting Last week, Congress passed the Consolidated Appropriations Act (CAA) of 2022, a $1.5 trillion governmental funding package.  Among its many provisions, the bill extends access to telehealth services for individuals who are covered under a health savings account (HSA)-qualified high deductible health plan (HDHP). Typically, HSA-qualified HDHPs cannotContinue reading “CAA of 2022 Includes Federal Extension to Telehealth Protections for HDHPs”

Recent Guidance Expands Preventive Care for Women

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting Under the ACA, non-grandfathered group health plans must provide benefits for “preventive care” on a first-dollar basis. This means such coverage must be provided at no cost to participants (i.e., no co-payments, co-insurance, or deductibles may be applied).  For this purpose, preventive care includes: Evidence-based items orContinue reading “Recent Guidance Expands Preventive Care for Women”

New Updates to Surprise Billing Independent Dispute Resolution Process

By: Megan Diehl, Manager, Compliance Consulting, MZQ Consulting Last week, a federal judge for the Eastern District of Texas invalidated a portion of the independent dispute resolution (IDR) process outlined in the interim final rules for the No Surprises Act (the Act).  The Act, which applies to plan years that take effect on or afterContinue reading “New Updates to Surprise Billing Independent Dispute Resolution Process”

New Guidance on the Federal Surprise Billing Process

By: Lee Susan Spiegel The new federal prohibition on surprise billing first went into effect on January 1, 2022 (and applies to plan years beginning on or after that date).  The new rules prohibit providers from charging “out-of-network” rates for emergency care, air ambulance services, and all care by an “out-of-network” provider in an “in-network”Continue reading “New Guidance on the Federal Surprise Billing Process”

Additional Guidance Issued on OTC COVID-19 Test Mandate

By: Jessica Waltman, Principal, Forward Health Consulting On February 4, 2022, additional guidance was issued on the federal mandate requiring health plans to provide over-the-counter (OTC) COVID-19 tests at no cost to participants. As we have previously shared, plans are allowed to limit the total amount reimbursable to participants for out-of-network tests to $12/test—but, onlyContinue reading “Additional Guidance Issued on OTC COVID-19 Test Mandate”

OSHA Vaccine Mandate for Large Employers is Not Dead Yet

by: Jessica Waltman, Principal, Forward Health Consulting On January 25, 2022, the Occupational Safety and Health Administration (OHSA) announced that they are withdrawing the Vaccination and Testing Emergency Temporary Standard (ETS) that was adopted in November 2021, effective immediately. However, OSHA specifically notes that they are exclusively withdrawing the policy as an “enforceable emergency temporaryContinue reading “OSHA Vaccine Mandate for Large Employers is Not Dead Yet”

DOL FAQs Address Coverage for Colonoscopies and Birth Control

By: Jessica Waltman, Principal, Forward Health Consulting The ACA requires non-grandfathered health plans to pay for “preventive care” on a first-dollar basis, meaning that no copays, coinsurance, or deductibles can be charged for certain services defined as “preventive” under these rules.  In the same recent FAQs requiring health plans to pay for the cost ofContinue reading “DOL FAQs Address Coverage for Colonoscopies and Birth Control”

Supreme Court Strikes Down Vaccine or Testing Mandate for Large Employers, Upholds Requirement for Healthcare Workplaces

By: Jessica Waltman, Forward, Principal Health Consulting On January 13, 2022, the Supreme Court of the United States (SCOTUS) voted to block the continued enforcement of the federal Occupational Safety and Health Administration’s Emergency Temporary Standard (ETS) requiring large employers to either require all employees to obtain their COVID–19 vaccinations or submit to weekly virusContinue reading “Supreme Court Strikes Down Vaccine or Testing Mandate for Large Employers, Upholds Requirement for Healthcare Workplaces”

Biden Administration Announces 2023 Out-of-Pocket Limits and PCORI Fee for the Upcoming Year

By: Jennifer Berman, CEO, MZQ Consulting The Biden Administration recently announced the new out-of-pocket (OOP) limits that will apply to group and individual health plans during the 2023 plan year, as well as the Patient-Centered Outcomes Research Institute (PCORI) Fee for plan or policy years ending on or after October 1, 2021, and before OctoberContinue reading “Biden Administration Announces 2023 Out-of-Pocket Limits and PCORI Fee for the Upcoming Year”