On August 9, 2023, the Congressional Research Service (CRS) issued the Medicare Secondary Payer (MSP) Coordination of Benefits report. The CRS serves Congress in the legislative process by providing policy and legal analysis to committees and members of both the House and Senate, regardless of party affiliation. This report reviews the MSP system, reporting requirements, Medicare beneficiary responsibility, payer liability issues...

On August 11, 2023, the DOL, HHS, and IRS (“the agencies”) issued FAQs regarding administrative fees charged to group health plans, insurers, and out-of-network providers involved in payment disputes subject to the independent dispute resolution (IDR) provisions of the No Surprises Act (NSA).

Recently, HHS issued the first in a series of five annual reports to Congress on the impact of the No Surprises Act (NSA). The NSA was enacted in 2020 to address certain instances of surprise billing, where individuals receive unexpectedly high medical bills after receiving treatment, either unknowingly or unavoidably, by an out-of-network (OON) provider, facility, or provider of air ambulance services subject to NSA requirements.

On July 25, 2023, the Third Circuit Court of Appeals (the Third Circuit) affirmed an award of damages for retaliation by the United States District Court for the Western District of Pennsylvania. One of the plaintiff’s claims was based on ERISA Section 510, which makes it unlawful to discharge a participant or beneficiary for exercising a right under an employee benefit plan or for the purpose of interfering with the attainment of any right under the plan.

On July 25, 2023, the DOL and CMS released the 2022 MHPAEA Enforcement Fact Sheet. The fact sheet, which is provided annually, summarizes enforcement data and results from MHPAEA investigations closed by the DOL and CMS in the prior fiscal year.

On July 25, 2023, the DOL, Department of the Treasury, and HHS (the departments) released the 2023 MHPAEA Comparative Analysis Report to Congress (“the 2023 Report”). The 2023 Report highlights the departments’ enforcement efforts regarding MHPAEA’s non-quantitative treatment limitations (NQTLs) (e.g., prior authorization and benefits exclusions) during the second year of the Consolidated Appropriations Act, 2021 (CAA, 2021)...

On July 25, 2023, the DOL issued a technical release accompanying the MHPAEA proposed rules (Please see our article entitled Departments Announce Proposed Rules to Strengthen MHPAEA, also featured in this edition of Compliance Corner.)

On July 25, 2023, the DOL, HHS, and IRS (the departments) announced proposed rules under MHPAEA aimed at ensuring that people seeking coverage for mental health and substance use disorders can access treatment as easily as people seeking coverage for medical treatments.

On June 7, 2023, the Eighth Circuit Court of Appeals affirmed the district court’s denial of a bariatric surgery patient’s claims. The ruling was based upon the plan’s exclusion of claims for weight loss procedures and related complications.

On June 14, 2023, the CMS launched a dedicated website with resources and customer service information to educate patients, providers and insurers about the No Surprises Act surprise billing rules that protect patients from unexpected out-of-network medical bills.