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11.
Text of Tri-Agencies Proposed Regs: Federal Independent Dispute Resolution Process
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 27, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 27, 2023
443 pages. "These proposed rules would set forth new requirements relating to the disclosure of information that group health plans and health insurance issuers offering group or individual health insurance coverage must include along with the initial payment or notice of denial of payment for certain items and services subject to the surprise billing protections in the No Surprises Act. These proposed rules would also require plans and issuers to communicate information by using claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), as specified in guidance, when providing any paper or electronic remittance advice to an entity that does not have a contractual relationship with the plan or issuer. This document also proposes to amend certain requirements related to the open negotiation period preceding the Federal IDR process, the initiation of the Federal IDR process, the Federal IDR dispute eligibility review, and the payment and collection of administrative fees and certified IDR entity fees. This document also proposes to define bundled payment arrangements, amend requirements related to batched items and services, and amend the rules for extensions of timeframes due to extenuating circumstances. Additionally, this document proposes to require plans and issuers to register in the Federal IDR portal."
12.
Text of Agencies' Request for Information: Coverage of Over-the-Counter Preventive Services
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 12, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Oct. 12, 2023
"[Treasury, DOL and HHS] are issuing this RFI to gather input from the public regarding the potential benefits and costs of requiring non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover OTC preventive items and services without cost sharing and without a prescription by a health care provider; seek comment on any potential challenges associated with providing such coverage; understand whether and how providing such coverage would benefit consumers; and assess any potential burden that plans and issuers would face if required to provide such coverage."
13.
Text of Agencies Extension of Comment Period for Proposed MHPAEA Regs (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Sept. 20, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Sept. 20, 2023
"This document extends the comment period for the proposed rules entitled 'Requirements Related to the Mental Health Parity and Addiction Equity Act' that were published in the August 3, 2023, issue of the Federal Register. The comment period for the proposed rules, which had been scheduled to close on October 2, 2023, is extended 15 days to October 17, 2023."
14.
Agencies Announce Proposed Rules to Strengthen Mental Health Parity and Addiction Equity Act
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 25, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 25, 2023
"With the proposed rules and technical release, the departments aim to promote changes in network composition and plans' and issuers' medical management techniques to make mental health and substance use disorder provider networks more accessible and create parity in treatment limitations, such as network composition standards and prior authorizations, for people seeking mental health and substance use disorder treatment."
15.
EBSA, HHS and Treasury MHPAEA Guidance Compendium
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 25, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 25, 2023
"This document provides the citations to the MHPAEA Final and Interim Final Rules and the guidance the Departments have issued for each category of violation cited in DOL's and HHS's FY22 MHPAEA Enforcement Fact Sheet."
16.
Text of Agency Proposed Regs: Requirements Related to the Mental Health Parity and Addiction Equity Act
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 25, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 25, 2023
395 pages. "This document proposes amendments to regulations implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and proposes new regulations implementing the nonquantitative treatment limitation (NQTL) comparative analyses requirements under MHPAEA... Specifically, these proposed rules would amend the existing NQTL standard to prevent plans and issuers from using NQTLs to place greater limits on access to mental health and substance use disorder benefits as compared to medical/surgical benefits. As part of these changes, these proposed rules would require plans and issuers to collect and evaluate relevant data in a manner reasonably designed to assess the impact of NQTLs on access to mental health and substance use disorder benefits and medical/surgical benefits, and would set forth a special rule with regard to network composition. ... [T]hese proposed rules would set forth the content requirements for NQTL comparative analyses and specify how plans and issuers must make these comparative analyses available to the Department of the Treasury, the [DOL], and [HHS], as well as to an applicable State authority, and participants, beneficiaries, and enrollees. The Departments also solicit comments on whether there are ways to improve the coverage of mental health and substance use disorder benefits through other provisions of Federal law. Finally, HHS proposes regulatory amendments to implement the sunset provision for self-funded, non-Federal governmental plan elections to opt out of compliance with MHPAEA, as adopted in the Consolidated Appropriations Act, 2023."
17.
Text of Agency Proposed Regs: Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; Etc.
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 7, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 7, 2023
182 pages. "This document sets forth proposed rules that would amend the definition of short-term, limited-duration insurance, which is excluded from the definition of individual health insurance coverage under the Public Health Service Act. This document also sets forth proposed amendments to the requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets. This document further sets forth proposed amendments to clarify the tax treatment of certain benefit payments in fixed amounts received under employer-provided accident and health plans. Finally, this document solicits comments regarding coverage only for a specified disease or illness that qualifies as excepted benefits, and comments regarding level-funded plan arrangements."
18.
Text of Agency FAQs, Part 60: Limitations on Cost Sharing Under the ACA; No Surprises Act and Transparency in Coverage with Regard to Facility Fees (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 7, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
July 7, 2023
"[1] Is cost sharing for services furnished by a nonparticipating provider, facility, or provider of air ambulance services (as defined for purposes of the No Surprises Act) considered cost sharing for benefits provided outside of a plan's network for purposes of the MOOP limit? Yes.... [2] The Departments are aware that some plans and issuers have contractual relationships with providers, facilities, or providers of air ambulance services that the plans and issuers do not consider to be part of their network. May a plan or issuer treat a provider, facility, or provider of air ambulance services with which it has a contractual relationship as out-of- network for purposes of the MOOP limit under PHS Act section 2707 and ACA section 1302(c), while also treating them as participating for purposes of the No Surprises Act? No.... [3] Are facility fees included in the definition of items and services for purposes of the TiC Final Rules and the GFE requirements of the No Surprises Act? Yes."
19.
Text of Agency FAQs Part 59: Coverage of Preventive Services
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Apr. 13, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Apr. 13, 2023
"The Departments disagree with the District Court's ruling and are considering all available options in consultation with the Department of Justice; the Department of Justice filed a notice of appeal on March 31, 2023, and a motion for a stay on April 12, 2023.
"The Departments are issuing these FAQs to provide initial guidance on how the Braidwood decision affects the requirement to cover preventive services without cost sharing under PHS Act section 2713. The Departments anticipate issuing additional guidance in the future to further address plans' and issuers' obligations under PHS Act section 2713(a)(1) in light of the Braidwood decision.
Which USPSTF-recommended items and services are affected by the Braidwood decision?
Following the Braidwood decision, are plans and issuers required under PHS Act section 2713 to continue to provide coverage, without cost sharing, for items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010?
Does the Braidwood decision affect the requirements under PHS Act section 2713(a)(2)-(4) to provide coverage without cost sharing for immunizations recommended by ACIP or preventive care and screenings for infants, children, and adolescents, as well as for women as provided for in comprehensive guidelines supported by HRSA?
Does the Braidwood decision prevent states from enacting or enforcing state laws that require health insurance issuers offering group or individual health insurance coverage to provide coverage, without cost sharing, for items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010?
To the extent a plan or issuer is permitted and elects to make changes to its coverage, may it make those changes in the middle of the plan or policy year?
Must plans and issuers notify participants, beneficiaries, and enrollees if they change the terms of their coverage with respect to USPSTF-recommended items and services that were affected by the Braidwood decision?
Following the Braidwood decision, may an HDHP continue to provide benefits for items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010 before the minimum annual deductible under Code section 223 has been met?
How does the Braidwood decision affect the requirement under CARES Act section 3203 to cover qualifying coronavirus preventive services?
Are carriers offering plans in the Federal Employees Health Benefits Program required to continue to cover items and services recommended with an 'A' or 'B' rating by the USPSTF on or after March 23, 2010?"
20.
Text of Federal Independent Dispute Resolution (IDR) Process Guidance for Certified IDR Entities (PDF)
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Mar. 19, 2023
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
Mar. 19, 2023
43 pages; updated Mar. 2023. "This guidance document is effective for payment determinations made on or after February 6, 2023 for items and services furnished on or after October 25, 2022 for plan years ... beginning on or after January 1, 2022 ... This document includes information on how the parties to a payment dispute may initiate the Federal IDR Process and describes the requirements of the Federal IDR Process, including the requirements that certified IDR entities must follow in making a payment determination. This document also includes ... guidance on confidentiality standards, record-keeping requirements, and the process for revocation of IDR certification, as well as how parties may request an extension of certain time periods for extenuating circumstances."
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