Insights

On February 23, 2022, in Texas Medical Association vs. HHS, a Texas district court struck down key parts of the federal rule governing the surprise billing independent dispute resolution (IDR) process of the No Surprises Act (NSA). The vacated provisions of the NSA's Interim Final Rule Part II (the 'Rule') prescribed the methodology for determining the out-of-network (OON) payment amount for disputed claims between healthcare providers and group health plans or insurers. (For more information o

Since March 2020, employers of all sizes have been required to provide unpaid leave under DCFMLA to employees for reasons related to COVID-19. Separately, since November 18, 2021, employers of all sizes have been required to provide two hours of paid leave for employees receiving (or their child receiving) a COVID-19 vaccination and an additional eight hours of paid leave in the following 24-hour period for vaccination recovery. Both requirements were set to expire on February 16, 2022, and wer

Employers who employ at least one employee in Washington State are subject to Washington PFML. One of the requirements of PFML is that covered employers must file a report and remit the required premium on a quarterly basis through the Employment Security Department's SecureAccess.wa.gov portal. The state recently announced that covered employers can view the status of submitted reports on their portals and verify that their filed reports are successfully processed. If a report fails to be pro

Mergers and acquisitions contain representation and warranty clauses that tie directly to the knowledge of the seller and purchaser parties. In most transactions, the seller's representations and warranties are heavily negotiated between the parties, as they are a principal mechanism by which the purchaser transfers some of its risks in the transaction from itself to the seller. In this way, the seller provides the buyer with specific assurance regarding the contemplated deal, including materia

The IRS rules generally don't allow employers to discriminate on benefits in favor of highly compensated employees. Check out our recent webinar, where we discussed the different nondiscrimination rules that apply to group health and welfare plans. In addition to outlining the rules, the team also discusses practical considerations of implementing plans that will not fail nondiscrimination testing and highlights correction methods that can be taken should a plan be deemed discriminatory. B

The Department of Health posted the 2022 covered-lives assessment (CLA) rates for professional education under the Health Care Reform Act (HCRA). These rates are applicable to health claim payers (including self-insured plans) that elect to pay the assessment directly to the state rather than facing higher surcharges for in-state hospital expenses. The annual amount owed by the payer is calculated based upon the number of covered individuals and families residing in the state. The HCRA was enac

ALEs are employers who employ on average at least 50 full-time employees (including equivalents) on a controlled group basis in the previous calendar year. ALEs are subject to the ACA employer mandate as well as annual ACA reporting via Forms 1094 and 1095-C. For the 2021 reporting, ALEs need to file Forms 1094 and 1095-C with the IRS by February 28, 2022, if filing by mail (available only for ALEs who file fewer than 250 forms) or March 31, 2022, if filing electronically. Additionally, by Marc

As background, the No Surprises Act (the Act) prohibits out-of-network healthcare providers from imposing balance bills for emergency services and air ambulance services. Similarly, out-of-network healthcare providers working at in-network facilities may not impose balance bills for certain nonemergency services, including anesthesiology and radiology services. As an integral part of the Act, the regulations established the Federal Independent Resolution (IDR) process for out-of-network provide

On January 31, 2022, the US Court of Appeals for the First Circuit (First Circuit) reversed the District Court in a case that centers on the Mental Health Parity and Addiction Equity Act (MHPAEA). In N.R. v. Raytheon Company, the plaintiffs brought a case against Raytheon, United Healthcare, and the plan's administrator on behalf of their minor child after the plan refused to pay for the child's speech therapy. The plaintiff's main argument (in count 3) was that the plan's exclusion of non-rest