Affordable Care Act

Subscribe to Affordable Care Act via RSS

At the end of June, the U.S. Court of Appeals for the Fifth Circuit affirmed a district court order invalidating the Affordable Care Act preventive services mandate for “A” or “B” items and services recommended by the United States Preventive Services Task Force (USPSTF) on or after March 23, 2010, on the basis that the…

On Tuesday, the U.S. Court of Appeals for the Fifth Circuit approved the parties’ stipulated agreement to stay enforcement of the district court decision in Braidwood Management Inc. v. Becerra until the appeal is resolved (with a limited exception for the named plaintiffs).  As readers will recall from our prior blog, in Braidwood, a district court had enjoined enforcement of the preventive services mandate for “A” or “B” items and services recommended by the United States Preventive Services Task Force (“USPSTF”) on or after March 23, 2010.  If the district court decision stands, non-grandfathered health plans would not have to cover those particular preventive services without cost-sharing.

On Monday, the U.S. Court of Appeals for the Fifth Circuit issued an administrative stay of enforcement of the district court decision in Braidwood Management Inc. v. Becerra.  Readers of our earlier blog (found here) will remember that in Braidwood, the district court enjoined enforcement of the preventive services mandate for “A” or “B” items and services recommended by the United States Preventive Services Task Force (“USPSTF”) on or after March 23, 2010.  If the district court decision stands, this means that non-grandfathered plans would not have to cover these services without cost-sharing.  However, as a result of the Fifth Circuit stay issued on May 15, non-grandfathered health plans will continue to be subject to the mandate for these services for the time being.  All other preventive care requirements for health plans remain in place.

The Departments of Labor, Treasury, and Health and Human Services (the “Departments”) recently released guidance for group health plans on required preventive services coverage.  The guidance was issued in response to a federal district court decision in a case called Braidwood Management, Inc. v. Becerra that enjoined enforcement of the preventive services mandate for items and services with an “A” or “B” rating from the United States Preventive Services Task Force (“USPSTF”) on or after March 23, 2010. The Departments issued this guidance to clarify the current scope of the preventive services mandate in light of the court’s decision.

On the heels of several recent court decisions concerning gender-affirming care, a federal district court in Washington concluded that the denial of benefits for gender-affirming care by a third-party administrator (“TPA”) administering a self-insured plan violated Section 1557 of the Patient Protection and Affordable Care Act (the “ACA”).  By way of background, Section 1557 sets…

On December 15, 2022, the Internal Revenue Service (“IRS”) published final regulations that make permanent certain relief and changes relating to the Affordable Care Act (“ACA”) reporting requirements. Specifically, the final regulations (1) include an automatic 30-day extension for providing Forms 1095-B and 1095-C to covered individuals and employees, which would otherwise be due on…

Updated November 15, 2022

On October 11, 2022, the IRS and the Treasury Department released final regulations relating to premium tax credit eligibility for families, along with companion cafeteria plan guidance in Notice 2022-41.[1]  The final regulations are expected to extend eligibility for premium tax credits to some dependents who were previously ineligible for…

The Internal Revenue Service (“IRS”) recently issued proposed regulations affecting certain reporting deadlines under the Patient Protection and Affordable Care Act (“ACA”).  Specifically, proposed regulations would make permanent an automatic 30-day extension for issuing Forms 1095-B and 1095-C to covered individuals and employees, which would otherwise be due by January 31. The proposed regulations also…

A recently released redacted report from the Treasury Inspector General for Tax Administration (TIGTA) offers some helpful insights for employers who may be assessed shared responsibility payments because the IRS thinks they failed to offer adequate health coverage, as required by the Affordable Care Act (ACA).

The TIGTA report shows a wide gap between the…

Roughly a year ago, we reported on a district court judge’s determination that the Affordable Care Act’s (“ACA”) individual mandate was unconstitutional and that, therefore, the entire ACA was invalid. A detailed summary of the district court’s decision can be found in our December 17, 2018 post. Not surprisingly, this ruling was appealed to…