On Thursday, May 23, 2019, the Senate Health Committee proposed a bipartisan bill called the Lower Health Care Costs Act. This bill sets out to address surprise medical billing, reduce the cost of prescription drugs and the overall cost of delivering health care, and improve transparency. The proposed bill is the latest move federal officials…
Beginning in May of last year, the Trump administration began searching for ways to curb out- of-control prescription drug costs—referring to the initiative as American Patients First. This effort is finally seeing some traction, with the administration publishing its first final rule on the matter. Drug companies will now be “… required to disclose to…
On Monday, July 29, 2019, the Centers for Medicare and Medicaid (CMS) proposed rules that would require all Medicare-participating hospitals to post their negotiated prices for standard health care services. The Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule is intended to increase pricing transparency and help consumers understand the charges…
On Friday, Nov. 15, 2019, the Trump administration released its final rule regarding hospital price transparency. This final rule will take effect Jan. 1, 2021, a year later than originally proposed. The Centers for Medicare and Medicaid Services (CMS) had been listening to feedback on a proposed version of the rule for the past four…
On June 24, 2019, President Trump issued an Executive Order (“EOâ€) directing the relevant federal agencies to issue regulations or other guidance to make available more meaningful information related to the price and quality of healthcare. This summary highlights aspects of the EO that may be relevant to employer-sponsored group health plans and their covered…
A bill has been introduced in New Jersey in both the Senate and Assembly that, if passed, would prohibit insurance carriers or other insurers subject to the insurance laws of New Jersey or any other state from offering, issuing or renewing any stop loss insurance policy of any kind to small employers. Stop loss insurance…
On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret†ERISA when issuing these rules by: expanding the definition of “employers†to include disparate groups of…
While ERISA fiduciaries have often been challenged for allowing an ERISA retirement plan to pay excessive fees and expenses (such as in the context of a 401(k) plan), such claims have rarely been raised against ERISA fiduciaries of a group health plan. However, the Department of Labor (“DOLâ€) recently sued a group health plan raising…
Apr 2019 – This article is intended to provide you with an update on current legal challenges to invalidate the ACA. There is no immediate impact to employer-sponsored health plans or other requirements under the ACA. In 2018, a Texas Court ruled in favor of 20 Republican state attorneys general (“AGsâ€) to invalidate the…
On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret†ERISA when issuing these rules by: expanding the definition of “employers†to include disparate groups of…