Gender-affirming care has become a central topic in US political discussions, significantly affecting employer-sponsored group health plans. Depending on whether they purchase insurance or self-fund their health benefits, group health plan sponsors face different challenges in covering gender-affirming care. In this PlanSponsor article, Alden Bianchi, Sarah Raaii, and Scott Kenkel explore these challenges and share best practices for group health plans to navigate this complex issue.
The No Surprises Act, a law that ended the practice of “balance billing” by certain out-of-network providers, was enacted as part of the Consolidated Appropriations Act of 2021 on December 27, 2020. While the law was passed during President Trump’s first term in office, the Biden administration has been fully responsible for its implementation to date.
In this insight, McDermott+’s Jeffrey Davis and Kristen O’Brien highlight four major areas of No Surprises Act implementation that the Trump administration could decide to focus on in the months following the inauguration.
On October 29, 2024, the US Department of Justice (DOJ) issued a proposed rule to implement US President Joe Biden’s Executive Order (EO) 14117. This order aims to prevent countries of concern from accessing Americans’ sensitive personal data and US-government-related data. The proposal specifically includes health data as a category of sensitive personal data that could be exploited. Health insurers, service providers to health plans, and healthcare providers should review this proposed rule closely.
Sarah Raaii recently joined McDermott+’s Maddie News on the Health Policy Breakroom Podcast to discuss proposed rules issued by the Biden administration that require health plans to cover certain over-the-counter services, including contraception items.
Alden Bianchi, Jake Mattinson, and Sarah Raaii recently authored an article in ALM Benefits Pro commenting on the final Mental Health Parity and Addiction Equity Act (MHPAEA) regulations issued last month by the Biden administration. While some of the more objectionable features of the proposed MHPAEA regulations were not finalized, they argue that their basic structure remains fully intact, including provisions that employers found most burdensome.
On September 9, 2024, the Biden administration issued much-anticipated final regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA). The rules implement a host of complicated new compliance requirements for sponsors and issuers of health plans, instituting new obligations to collect and evaluate plan data, conduct comparative analyses, and act to address material differences in access to mental health and substance abuse benefits as compared to medical and surgical benefits.
During a recent webinar, Alden Bianchi, Jake Mattinson, and Sarah Raaii provided a comprehensive overview of the new rules, including compliance deadlines and key takeaways for employers, plan sponsors, and issuers of group health plans. The speakers also addressed how the new rules might impact any ongoing US Department of Labor investigations.
On August 12, 2024, the Biden administration launched a new “Time Is Money” initiative, seeking to crack down on time-consuming and burdensome business processes.
The initiative includes a requirement for federal employee health plans to provide an online opportunity to submit claims. It also features an accompanying letter to health insurance CEOs from the heads of the US Department of Health and Human Services and US Department of Labor that challenges the CEOS to offer online claim submissions, deny claims only where appropriate, and provide clear steps to appeal decisions.
Read more about the initiative and other McDermott+ healthcare-related regulatory updates here.
The Biden administration recently released its Spring 2024 Unified Agenda (a few months late), which lists all the regulations that the administration plans to issue by the end of the year and beyond.
In this update, Jeffrey Davis previews new regulations that could impact the health and welfare benefits industry related to the No Surprises Act, new standards for the exchange of health information under the Health Insurance Portability and Accountability Act, the finalization of new Mental Health Parity and Addiction Equity Act rules, and more.
Democratic lawmakers recently sent a letter to the US Office of Personnel Management urging the Biden administration to enhance the Federal Employees Health Benefits Program’s in vitro fertilization coverage. The letter comes as some states have signaled an interest in enforcing personhood rights in treatments involving embryos, according to this Federal Times article.
“When you can’t receive the services within a state, obviously it doesn’t do you much good if your [insurance] plan still technically covers them,” said Sarah Raaii.
On April 23, 2024, the Federal Trade Commission (FTC) voted 3-2 along party lines to ban all new noncompete agreements nationwide and render existing noncompete agreements binding most workers unenforceable. The Final Rule, slated for publication in the Federal Register, provides that employers’ use of noncompete agreements amounts to an “unfair method of competition” that runs afoul of Section 5 of the FTC Act.
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FTC’s Final Noncompete Rule: What It Means and Next Steps for Employers
Wednesday, May 8, 2024
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