Newsletters

10.30.24

Administration Proposes Rules on OTC Contraception and Utilization Management in Preventive Care

On October 21, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) issued a proposed rule on permissible utilization management techniques for preventive services and the required coverage of over-the-counter (OTC) contraceptives without cost-sharing, in ...


10.16.24

Maximum Cost-Sharing Limit Jumps for 2026, CMS Releases Additional Marketplace Guidance

The maximum out-of-pocket limitation (MOOP) will rise by 10 percent in 2026 for most commercial health plans, according to newly finalized cost sharing calculations from the Centers for Medicare & Medicaid Services (CMS).


10.10.24

CMS Proposed 2026 Notice of Benefit and Payment Parameters Rule Focuses on Marketplace Oversight

On October 4, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters (NBPP) for plan year 2026.


06.25.24

Fifth Circuit Rules Preventive Services Mandate Unconstitutional

In a keenly anticipated decision, Braidwood Management v. Becerra, the U.S. Court of Appeals for the Fifth Circuit ruled June 21 that the law requiring commercial health plans to cover without cost sharing certain preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) ...


06.20.24

Florida’s Ban on Gender-Affirming Care Impermissible, New 1557 Challenge Filed

Litigation continues on state laws and policies related to gender-affirming care.  


06.20.24

CFPB Proposes Rule to Remove Medical Debt from Credit Reports

The Consumer Financial Protection Bureau (CFPB) released a proposed rule on June 11 that it says would remove $49 billion in medical debt from the credit reports of 15 million people.


06.05.24

Nevada to Mandate Counting of Manufacturer Discounts in Patient Cost-Sharing

Nevada’s Division of Insurance (DOI) announced that it will require state-regulated health plans to apply manufacturer assistance to an enrollee’s cost-sharing obligations under a plan, except when a generic alternative is available


05.15.24

Florida Challenges New Federal Nondiscrimination Rules

On May 6, the state of Florida and medical providers filed a lawsuit against HHS, claiming the provisions on gender identity in the Section 1557 nondiscrimination final rule, published on the same day, violate the Administrative Procedure Act (APA), the Spending Clause, and the First Amendment.


05.01.24

New York’s 1332 Waiver Extends Affordable Coverage to Additional Groups

On March 1, the Departments of Health and Human Services (HHS) and the Treasury approved New York’s section 1332 waiver that expands affordable coverage to additional groups of New Yorkers.


11.14.23

Proposed Rule Intended to Smooth No Surprises Act Independent Dispute Resolution Operations

On October 27, the Departments of Health and Human Services (HHS), Labor and the Treasury and the Office of Personnel Management (the Departments) released a proposed rule to revamp certain aspects of the No Surprises Act’s (NSA) independent dispute resolution (IDR) process for out-of-network ...