Regulatory & Legislative Issues

Nothing written by SPBA is legal advice.

Regulatory & Legislative Issues

Articles and Materials

Enforcement Relief for Gag Clause Prohibition Compliance Attestation (4/30/25)

Unleashing Prosperity Through Deregulation (2/25/25)

Ozempic, Wegovy Among 15 Drugs Selected for Medicare Price Negotiations (2/25/25)

Legislative Update – Prospects for Telehealth Movement in the Lame Duck Session (12/17/24)

Trump Administration Implications for Healthcare: The Issues and People to Watch (12/4/24)

House Committee Tees Up Telehealth Bill (10/24/24)

Health Subcommittee Examines Proposals to Extend Telehealth Flexibilities (4/25/24)

Richard Hardin Testimony for the Record (4/12/24)

SPBA submits comment letter to the House Committee on Education and the Workforce (4/5/24)

Bipartisan Group of Senators Introduce Legislation to Reduce Employer Healthcare Reporting Requirements (11/15/23)

National Emergency or Public Health Emergency Declaration (9/7/22)

Official Source Documents

President Trump Issues Executive Order Directing Efforts to Lower Prescription Drug Prices (4/28/25)

Trump Executive Order on Transparency (2/28/25)

Abortion

Articles and Materials

HHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on Roe (7/6/22)

Supreme Court Decision on Abortion (7/5/22)

Official Source Documents

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet (7/14/22)

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care (7/14/22)

Access/Protection

Articles and Materials

National Medical Support Notice (8/15/19)

USA PATRIOT Act Update (8/15/19)

USA Patriot Act: TPAs Hit With OFAC Regs (8/15/19)

Insurer Duties Under USA PATRIOT Act (8/15/19)

Limited Use of Social Security Numbers (8/15/19)

Purchaser Guide for Employers on Value-Driven Health Care (2/8/07)

AHP (Association Health Plans)

Articles and Materials

Association Health Plans Subject to Guidance of the ACA Past (4/30/24)

Association Health Plans Proposed Regulations Released + AHP Regulation Overview (8/15/19)

Association Health Plans Regulations Under Consideration by DOL (8/15/19)

AHP Comment Letter on Behalf of SPBA (8/15/19)

Department of Labor Final Regulations Expanding ERISA's Definition of "Employer" to Provide Access to Association Health Plans + FAQs (8/15/19)

Official Source Documents

Association Health Plans: ERISA Compliance Assistance (8/15/19)

Definition of "Employer" under Section 3(5) ERISA - Association Health Plans (Proposed Rule) (8/15/19)

Association Health Plans - Final Rule (8/15/19)

Air Ambulance

Articles and Materials

Air Ambulance and Patient Billing Advisory Committee Report #1 (7/15/21)

Air Ambulance Letter to Senate (8/8/18)

Americans with Disabilities Act

Articles and Materials

Court Holds ADA Covers Gender Dysphoria (9/7/22)

EEOC Advises Employers Utilizing Artificial Intelligence Software (7/5/22)

EEOC Expands ADA's Definition of "Disability" (8/15/19)

Judge Dismisses Challenge to Wellness Program (8/15/19)

ADA Amendments Act of 2008 (8/15/19)

ADA Speech Handout (8/15/19)

Questions and Answers on the Notice of Proposed Rulemaking for the ADA Amendments Act of 2008 (8/15/19)

Pregnancy Discrimination: EEOC Delivers New Guidance on Pregnancy Discrimination under ADA Duties (article) (7/31/14)

Official Source Documents

Pregnancy Discrimination: Press Release: EEOC Issues Updated Enforcement Guidance on Pregnancy & Related Issues (Link) (8/4/14)

Pregnancy Discrimination: Enforcement Guidance: Pregnancy Discrimination & Related Issues (Link) (8/4/14)

Pregnancy Discrimination: Q & As about the EEOC's Enforcement Guidance on Pregnancy Discrimination & Related Issues (Link) (8/4/14)

Cafeteria Plans

Articles and Materials

2025 Health FSA Inflation-Adjusted Amounts (12/9/24)

Health FSA Inflation-Adjusted Amounts for 2024 (11/12/23)

IRS Issues Notice Expanding Some Permitted Change-in-Status Rules for Cafeteria Plans (12/1/22)

2021 COLAs for "HCP" and "Key" in Cafeteria Plans (12/1/20)

A. 2019 COLAs for "HCP" and "Key" in Cafeteria Plans (11/13/18)

B. 2018 COLAs for "HCP" and "Key" in Cafeteria Plans (11/30/17)

Official Source Documents

IRS Notice 2020-90: COVID-19 Guidance Under § 125 Cafeteria Plans and Related to High Deductible Health Plans (9/28/20)

125 Elections & MarketPlace Coverage (9/19/14)

$500 Rollover Guidance (11/20/13)

IRS Notice on FSA Carryover (10/31/13)

2001 Regulations on Election Changes (5/28/10)

2000 Regulations on Election Changes (5/28/10)

IRS Notice on FSA Distributions for Reservists (11/21/08)

Federal Register: Final Rules on Dependent Care Services (8/28/07)

Federal Register: Proposed Cafeteria Plan Regulations, August 6, 2007 (8/10/07)

Debit Card IRS Revenue Ruling (12/8/06)

Preamble to Proposed Reg on Dependent Care Expenses (12/8/06)

Prop Reg § 1.21-1. Expenses for household and dependent care services necessary for gainful employment. (12/8/06)

IRS Notice on "Use-It-or-Lose-It" Grace Period (5/19/05)

Cafeteria Plans - Explanation and Commentary

Articles and Materials

IRS Issues Memo on FSA Claim Substantiation (5/26/23)

IRS Issues Notices to Relax Cafeteria Plan Election Rules for COVID-19 and Increase Health FSA Carryover (9/28/20)

$2,500 Health FSA Limit Guidance (7/17/12)

5500 Forms and Cafeteria Plans (12/8/11)

Cafeteria Plan Elections (11/16/09)

Cafeteria Plan Changes in the Economic Downturn (7/30/09)

Cafeteria Plans: Identifying Trouble Areas (11/5/08)

New Proposed Cafeteria Plan Regulations (1/23/08)

IRS Issues New Proposed Cafeteria Plan Regulations - John Hickman, Esq. Alston & Bird (10/11/07)

Cafeteria Plan Election Changes (12/8/06)

IRS Comments on Reimbursing Over-the-Counter Drugs (12/8/06)

IRS Notice on Debit Cards and Substantiation in FSAs (12/8/06)

IRS Suspends Requirement to File Schedule F of the 5500 Form for Cafeteria Plans (12/8/06)

Warning!! IRS Seeks to Audit for Debit Card Compliance (11/20/06)

Cafeteria Plans and Other Related Documents - Ashley Gillihan, Alston & Bird, LLP (10/31/06)

Debit Cards (10/24/06)

Chevron

Webinar

Webinar: The Chevron Decision: What You Need To Know (8/2/24)

CHIPRA

Articles and Materials

Employer CHIP Notices (8/15/19)

CHIPRA Notice Requirements (4/27/09)

Official Source Documents

CHIP DOL Release (8/15/19)

CHIP Model Notice Regs (Federal Register) (8/15/19)

Explanation of CHIP Model Notice (Federal Register 2-4-10) (2/4/10)

Model CHIP Notice (2/4/10)

COBRA

Articles and Materials

American Rescue Plan Act of 2021 Health Benefit Provisions (3/15/21)

DOL Issues FAQs and COBRA Model Notices (5/15/20)

Is a Spouse Entitled to COBRA when the Covered Employee Drops Coverage after Enrolling in Medicare? (1/3/20)

IRS Posts Reminder and Form for Reporting on COBRA Subsidy Recipients (8/16/19)

COBRA Tax Audits (8/16/19)

DOL Releases Final COBRA Notice Rules (8/16/19)

IRS on Family and Single COBRA Rates (8/16/19)

COBRA Model Notices (8/16/19)

Dependent Child Maternity under COBRA (8/16/19)

DOL Releases Updated Model COBRA Notices (8/16/19)

Refresher on Medicare as a Second Qualifying Event and COBRA (8/16/19)

FAQ 32 COBRA (8/15/19)

FAQ 32 COBRA (6/29/16)

Gillihan's COBRA Presentation (11/3/05)

Final COBRA Regulations & Other COBRA Guidance - Ashley Gillihan. Esq. Alston & Bird LLP (10/21/04)

Summary of Changes from 2003 Proposed COBRA Regulations - Hickman & Gillihan, Alston & Bird LLP (10/21/04)

Official Source Documents

Premium Assistance for COBRA Benefits (Notice 2021-31) (5/19/21)

FAQs About the ACA Implementation Part 32: COBRA & Health Insurance Marketplace (8/15/19)

1999 and 2001 Final COBRA Regs (8/16/09)

COBRA-ARRA

Articles and Materials

COBRA Model Notices (8/16/19)

DOL Posts Application for Review of Denial of COBRA Premium Reduction (8/16/19)

Fate of COBRA Subsidy and Health Reform PR (6/7/10)

COBRA Subsidy Extension (2/24/10)

COBRA Subsidy Extension Signed into Law (12/28/09)

Frequent ARRA COBRA Subsidy Questions (7/30/09)

Draft COBRA Subsidy Applications for Expedited Review of Denials (5/8/09)

No COBRA Premium Assistance Information Return Required (5/1/09)

COBRA Expanded for TAA Individuals (4/27/09)

ARRA COBRA Subsidy Issues Discussed at SPBA Spring Meeting (4/16/09)

ARRA COBRA Subsidy: Phase II (4/16/09)

ARRA Second Chance Election (4/9/09)

DOL Releases Clarifying Illustrations of which Model Notices to Send (4/3/09)

IRS Releases Guidance on Involuntary Termination in ARRA (4/2/09)

How Multi-Employer Plans Collect COBRA 65% Subsidy (4/1/09)

Which COBRA Subsidy Model Notice Should Be Sent? (3/30/09)

Top Issue on COBRA Subsidy Model Notices Today (3/20/09)

IRS Releases Information on Reducing Payroll Deposits for the COBRA Subsidy (3/12/09)

DOL Releases Some Guidance on the COBRA Subsidy (2/27/09)

COBRA Premium Update (2/23/09)

Official Source Documents

CMS COBRA Denial Application (5/8/09)

DOL COBRA Denial Application (5/8/09)

Defense of Marriage Act (DOMA)

Articles and Materials

Supreme Court Decides DOMA (8/17/19)

What is DOMA? and Why Is It Under Challenge (8/17/19)

DOL News Release: New Guidance Issued by the DOL on Same-sex marriages & Employee Benefit Plans (8/16/19)

Treasury Clarifies Federal Government Position on DOMA (8/16/19)

FMLA Proposed Regulation for Same Sex Marriage (2/25/15)

Health Reform: SCOTUS DOMA = Confusion for Plans & TPAS (7/8/13)

Official Source Documents

U.S. v. Windsor: Marketplace Guidance on Internal Revenue Ruling 2013-17 (10/4/13)

U.S. v. Windsor: A CMS Update (10/4/13)

Guidance to Employee Benefit Plans on the Definition of "Spouse" and "Marriage" under ERISA & The Supreme Court Decision (9/23/13)

H. Guidance to Employee Benefit Plans on the Definition of "Spouse" & "Marriage" under ERISA & the Supreme Court Decision (9/18/13)

Treasury Revenue Ruling 2013-17 + Treasury Answers on Same Sex Marriages + Treasury Revenue Ruling 2013-19 , DOMA + Treasury Press Release - DOMA (9/3/13)

U.S. v. Windsor: DOMA Opinion (6/26/13)

U.S. v. Windsor (11/1/12)

Disclosure of Fees

Articles and Materials

SPBA Comments on 408(b)(2) (9/20/11)

New DOL Proposed Rules on Disclosing TPA Compensation (1/14/08)

Official Source Documents

Temporary Enforcement Policy Regarding Group Health Plan Service Provider Disclosures (1/5/22)

Domestic Partners

Official Source Documents

IRS - FAQs for Same Sex Couples (10/7/19)

U.S. v. Windsor (11/1/12)

IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States (10/29/12)

DOL

Articles and Materials

Plan Asset Regulations (1/24/24)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

DOL Makes Claims Records Relevant (7/15/21)

Record Retention and Electronic Disclosure Rules (1/30/20)

ERISA Advisory Council Recommends DOL Action on SPDs (10/7/19)

Comprehensive Guidance on the DOL Claims (10/7/19)

DOL Releases Claims Regs Frequently Asked Questions (10/7/19)

Undocumented Aliens on the Employee Benefit Plan? (10/7/19)

DOL's Proposed FMLA Regulations & Expanded FMLA Leave to Family of MIlitary Service (10/7/19)

DOL Disclosure Rules (4/6/09)

Letter to Brokers, Clients and Friends of TPAs on the Disclosure of Commissions & Payments (7/8/08)

New DOL Proposed Rules on Disclosing TPA Compensation (1/14/08)

Broker Income and Float Income Addressed in the Proposed Revisions to the 5500 Form (12/8/06)

Claim Regulations Raises Fees Issue (12/8/06)

New SPD Requirements Under HIPAA (12/8/06)

SPD Disclosure Requirements Under HIPAA Confuse Many (12/8/06)

DOL Cracking down on Late-Paying Plans (3/2/00)

Official Source Documents

Level Funded Plan Arrangements Request for Comments (8/17/23)

DOL Releases 2020 Annual Self-Insured Health Plan Report to Congress + Summaries (2/10/21)

DOL Answers Questions for Joint Committee on Employee Benefits, 2011 (10/7/19)

Conflict of Interest (Part II - Rule) FAQs (10/7/19)

DOL Proposed Rule on TPA Fee Disclosure (10/7/19)

DOL Extension/Comments: Definition of "Plan Assets" & National Medical Support Notice (10/7/19)

DOL Extensions/Comments: ERISA Summary Annual Report (10/7/19)

DOL Extensions/Comments: Terminated Individual Account Plans (10/7/19)

DOL Reporting & Disclosure Guide for Employee Benefit Plans (10/7/19)

2017 DOL Annual Report on Self-insured Group Health Plans (3/1/17)

EDI/HIPAA Administrative Simplification

Articles and Materials

Administrative Simplification HIPAA Regulations Fact Sheet (7/7/22)

Administrative Simplification Reassociation Basics Fact Sheet (7/7/22)

OCR Updated the Health Data Breach Reporting Tool (12/13/21)

HHS Audit + HIPAA Administration Simplification Audit - Criteria (12/17/20)

ICD-10 Stop-Loss Disclosure Trigger List (9/23/15)

HHS Regulations Adopt Standards for HIPAA Electronic Funds Transfers (1/27/12)

Final Rules on EDI Transactions/Code Sets are Released (August 2000) (10/4/11)

National Provider Identifier Numbers Available (6/28/07)

HHS Provides Feedback on NPI (12/8/06)

TPA Websites for Providers and EDI (12/8/06)

CMS Alerts Regional Offices to Digital Healthcare (9/8/06)

Official Source Documents

HIPAA Administrative Simplification Regulations Overview (7/7/22)

EFT and ERA: Payment Remittance Reassociation Basics (7/7/22)

Administrative Simplification Compliance Resources (6/29/18)

Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities (7/29/15)

CMS-AMA ICD-10 Flexibilities Statement (7/29/15)

ICD-10 - Testing with CMS (7/29/15)

Federal Register: Updated Version of HIPAA Transactions Adopted (1/26/09)

National Provider Identifier Dissemination System (6/4/07)

CMS Announces Contingency Plan on NPI (4/27/07)

Federal Register 2004 Final Rule on National Provider Identifier (12/8/06)

Federal Register 2005 Proposed Rules HIPAA Standards for Electronic Health Care Claims Attachments (12/8/06)

EEOC

Articles and Materials

Pregnant Workers Fairness Act (4/26/24)

EEOC Releases New COVID Rules (9/7/22)

EEOC Nonbinary (7/5/22)

EEOC Advises Employers Utilizing Artificial Intelligence Software (7/5/22)

COVID-19 Fact Sheet for Employees (7/28/21)

What You Should Know About COVID-19 and the ADA, the Rehabilitation Act and other EEOC Laws (LINK (7/28/21)

Questions for the EEOC Staff for the 2015 Joint Committee of Employee Benefits Technical Session, May 7,2015 (10/7/19)

EEOC Fact Sheet: (FAQs) Domestic or Dating Violence, Sexual Assault, Stalking (Article) (10/7/17)

Official Source Documents

EEOC Guidelines on Sex & Pregnancy Discrimination Federal Register (10/5/17)

EEOC FAQs (Fact Sheet): Domestic or Dating Violence, Sexual Assault, Stalking (11/2/12)

5500 Forms

Articles and Materials

Schedule J Proposed in New 5500 Regulations (12/5/16)

DOL 5500 Form & Schedule J + Comment Letter (11/26/16)

Official Source Documents

Delinquent Filer Correction Program (2/8/21)

DOL Releases Advance Informational Versions of Form 5500 and Form 5500-SF (10/23/19)

Proposed DOL Rules on 5500 Form: Federal Register (7/28/16)

Proposed Revisions to Form 5500: Federal Register (7/28/16)

FMLA (Family Medical Leave Act)

Articles and Materials

FMLA Regs (1/29/20)

FMLA Proposed Regulation for Same Sex Marriage (2/25/15)

Wage and Hour Division (WHD) Family and Medical Leave Act (4/18/12)

FMLA Case Referral (12/21/10)

Official Source Documents

Definition of Spouse under the Family & Medical Leave Act: Fact Sheet (2/23/15)

Definition of Spouse under the Family & Medical Leave Act: FAQs (2/23/15)

Definition of Spouse under the Family & Medical Leave Act: Final Rule (2/23/15)

FTC (Federal Trade Commission)

Articles and Materials

FTC Publishes Final Rule Updating the Health Breach Notification Rule (6/26/24)

Health Reimbursement Arrangements

Articles and Materials

Administration Finalizes New HRA Rule (6/14/19)

CMS Clarifies Payment in HRAs (12/8/06)

Historical Reminders about Patient-Directed Healthcare (PDHC) and Health Reimbursement Accounts (HRAs) (12/8/06)

Ken Harvey's Perspective on Consumer-Driven Health Plans (1/12/06)

Historical Practical Points about Patient-Directed & HRA In Your Market (10/31/02)

The Big Picture of Patient-Directed Health Care (9/1/02)

Historical Prognosis on Patient-Directed Health Care (7/1/02)

Official Source Documents

Individual Coverage HRA and Excepted Benefit HRA FAQs (1/9/20)

IRS Guidance on Small Employer HRAs (IRS Notice 2017-67) (11/2/17)

HRA - IRS Notice 2002-45 (12/8/06)

HRA - IRS Revenue Ruling 2002-41 (12/8/06)

Health Savings Accounts

Articles and Materials

IRS Releases HSA Inflation Adjusted Amounts for 2025 (5/28/24)

IRS Releases HSA Inflation Adjusted Amounts for 2024 (5/26/23)

Congress Extends Telehealth Flexibility for Two Years (1/17/23)

HSA Contribution Limits for 2020 (1/3/20)

IRS Expands Preventative Care Benefits Permitted to be Provided under a High Deductible Health Plan (1/3/20)

Treasury Releases Guidance on Additional Preventive Care Benefits Permitted by HDHP (7/18/19)

IRS Releases New Guidance on 2018 HSA Contribution Limits & IRS Rev. Proc. 2018-27 (4/27/18)

HSA 2018 Contribution Limits (4/24/18)

IRS Retirement Plan News (10/1/09)

The TPA & The HSA: How Not to be Just Like the Others (10/11/07)

Full-Year Contribution for Part-Year Coverage (5/24/07)

HSA Comparability Rule: A Legal but Practical Perspective - Ashley Gillihan, Alston & Bird, LLP (4/17/07)

Strategies for Promoting Health Savings Accounts (4/17/07)

HSA Provisions in the "Tax Relief and Health Care Act of 2006" (1/26/07)

A New TPA Profit Center: Educating Employees about HSAs (12/8/06)

Everything You Wanted to Know about HSAs: A Crash Course in Health Care Consumerism (12/8/06)

FSA Grace Period and HSA Eligibility Guidance Offers Only Short Term Relief (12/8/06)

FSA Interaction with HSAs (12/8/06)

Health Savings Accounts - First Analysis (12/8/06)

HSA Must Be Established before Qualified Medical Expenses Can Be Incurred (12/8/06)

HSA Opportunities for TPAs (12/8/06)

HSAs and ERISA (12/8/06)

Learn How to Make HSA Decisions (12/8/06)

SPBA Seattle Meeting Panel on Health Savings Accounts (12/8/06)

Treasury Releases More HSA Guidance - IRS Notice 2004-50 (12/8/06)

The President's Health Savings Account Proposals (5/3/06)

Gillihan's Overview of HSA Comparability Rules (11/3/05)

HSAs and Out-of-Pocket Maximum Carryovers (10/5/05)

Considering an HSA?. - Kathy McCormick, HSA Bank (5/2/05)

Teaching Tools Power Point (11/8/04)

Everything You Wanted to Know about HSAs (and then some) - HIckman & Gillihan, Alston & Bird LLP (10/21/04)

More IRS/Treasury HSA Guidance Interaction with FSAs and HRAs (5/12/04)

DOL Releases Guidance on ERISA Applicability to HSAs (4/12/04)

SPBA Insights on HSA Bank/Trustee Issues (2/9/04)

Official Source Documents

IRS Notice 2004-2 (11/14/14)

IRS Notice 2004-50 (7/30/10)

Custodial Account Form (7/10/08)

IRS Notice 2008-59: New Q & As on HSAs (6/27/08)

IRS Notice 2007-22 on FSA and HRA Rollovers to HSAs (2/16/07)

All About HSAs (12/8/06)

DOL FAB 2004-01 (12/8/06)

DOL FAB 2006-02 (12/8/06)

Final HSA Comparability Rules (12/8/06)

IRS Notice 2005-86, HSA and FSA Grace Period (12/8/06)

IRS Proposed Rules on Employer Comparable Contributions (12/8/06)

Treasury Guidance on Preventive Care (1/19/06)

Notice 2005-8 - 2% Shareholders (8/5/05)

HIPAA Opt Out

Articles and Materials

Reminder on Opt-Out Rules for State and Local Government Plans (5/3/11)

Official Source Documents

HIPAA Opt-Out Model Notice to Participants (4/25/11)

HIPAA Opt Out Model Election Form (4/25/11)

HHS

Articles and Materials

Health and Human Services Re-Issue Section 1557 Non- Discrimination Regulations (9/7/22)

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

Official Source Documents

Short-Term, Limited-Duration Insurance; Independent, Noncoordinated Excepted Benefits Coverage; Level-Funded Plan Arrangements; and Tax Treatment of Certain Accident and Health Insurance (8/17/23)

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

HIPAA and Privacy

Articles and Materials

New HIPAA Privacy Rules Following the Supreme Court Dobbs Ruling (12/16/24)

HIPAA Privacy Rule to Support Reproductive Health Care Privacy: Resources for Stakeholders and HIPAA Covered Entities or Business Associates (6/28/24)

OCR issues Updated Guidance on HIPAA Requirements for the use of Online Tracking Technologies (3/29/24)

HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes (12/30/20)

New Frequently Asked Questions on HIPAA and Health Plans Support Care Coordination and Continuity of Care (7/1/19)

HHS OCR Clarifies Direct HIPAA Liability of Business Associates (6/7/19)

The Supreme Court, CareFirst & Data Breach Lawsuits (2/27/18)

HIPAA Privacy Opioid Guidance (11/28/17)

HHS Modifies HIPAA In An Attempt to Address Gun Violence (1/29/16)

HIPAA Business Associate Agreements (8/27/14)

Revised 2013 Notice of Privacy Practices (Clean) (8/15/13)

Revised 2013 Notice of Privacy Practices (8/15/13)

Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans (4/17/13)

BAA and Subcontractor: Business Associate Agreement and Subcontractor Agreement (4/5/13)

HHS Releases Sample Language for Updating Agreements Under HIPAA (1/30/13)

HHS Releases Final HIPAA Rule (1/24/13)

ONC To Develop Model Notice of Privacy Practices for Consumers (9/12/12)

OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol FROM OCR’s EMAIL ALERT June 26, 2012 (7/17/12)

OCR Says Business Associates Will Not Be a Part of the Pilot Audit (2/24/12)

HHS To Conduct HIPAA Privacy and Security Audits (11/28/11)

HHS’ Office of Civil Rights Releases HIPAA Violations Report (9/27/11)

HIPAA Privacy Rule Accounting of Disclosures – COMMENTS Submitted by SPBA (8/17/11)

HHS Issues Proposed Rule on Disclosures of Electronic Medical Data (6/1/11)

HIPAA Privacy and the Model Notice of Adverse Benefit Determination (3/9/11)

The New HIPAA Privacy & Security Rules: What Is Now Required (10/1/09)

HHS Issues Breach Notification Rules (9/10/09)

4 Timely Alerts (2/8/07)

Authorization Sample Form (12/8/06)

BAA: Electronic Contract Language Memo (12/8/06)

BAA: Model Electronic Contract Language (12/8/06)

Beware PHI Retained in Computers after a Client is Terminated (12/8/06)

Complaint Sample Form (12/8/06)

Does HIPAA Privacy prohibit insurers or HMOs from releasing claims experience due to HIPAA Privacy? (12/8/06)

Employee Confidentiality Agreement and Training Certification (12/8/06)

Flowchart Brainstorming Tools (12/8/06)

HIPAA Privacy Impact on Employers (Letter to use with Clients) (12/8/06)

HIPAA PRIVACY: Overview for TPAs (12/8/06)

Memo Explaining HIPAA Privacy Documents (12/8/06)

Plan Sponsor’s Certification of Compliance (12/8/06)

Providers Misinterpreting HIPAA Privacy (12/8/06)

Request for Access to Protected Health Information (12/8/06)

Request for Amendment of Protected Health Information Sample Form (12/8/06)

Request for an Accounting of Certain Disclosures of Protected Health Information (12/8/06)

Request for Confidential Communications Sample Form (12/8/06)

Request for Restrictions on Use or Disclosure of Protected Health Information (12/8/06)

Sample Amendment to Plan Documents (12/8/06)

TPA Privacy Issues Addressed at SPBA 2003 Spring Meeting (12/8/06)

Privacy Considerations in Connection with Initiatives for Healthy Behavior & the HIPAA Enforcement Rule (5/3/06)

The HIPAA Security Standards: Practical Implementation Considerations - Dorthula Powell-Woodson (5/2/05)

SPBA Model Customer Service Scenarios (9/8/03)

Official Source Documents

HIPAA Privacy Rule to Support Reproductive Health Care Privacy - For Covered Entities and Business Associates. (6/28/24)

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet (7/14/22)

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care (7/14/22)

OCR Proposes Modifications to the HIPAA Privacy Rule to Empower Individuals, Improve Coordinated Care and Reduce Regulatory Burdens (Fact Sheet) (12/21/20)

HIPAA, Health Information Exchanges, and Disclosures of Protected Health Information for Public Health Purposes (12/21/20)

HIPAA Audit Protocol 2016 (9/22/16)

HIPAA Privacy Rule and National Instant Criminal Background Check System (1/28/16)

Personal Representative rights for another individual's health information (1/28/16)

Individuals' Right under HIPAA to Access their Health Information (1/28/16)

HIPAA Privacy in Emergency Situations (11/18/14)

2009 Interim Final Rules on Breach Notification (9/8/09)

HIPAA Security Guidance - HHS (4/17/07)

IRS

Articles and Materials

Nutritional Counseling: Is it a Medical Expense? (8/11/23)

Home Exercise Equipment for Obesity (8/8/23)

IRS Private Letter Ruling Holds Some Genetic Testing May Be Considered a Medical Expense (1/3/20)

2010 Excise Tax Requirements (2/2/10)

2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert) (2/2/10)

IRS Releases Guidance on Involuntary Termination in ARRA (4/2/09)

IRS Issues Additional Debit Card Transition Relief (12/9/08)

New Commandments to Live By: IRS Provides New Proposed Regulations (10/11/07)

Congress Reworks Dependent Definition (6/26/07)

1099 - IRS IIR Request (1/26/07)

IRS Issues Debit Card Transition Relief (12/15/06)

1099 - IRS Hints (12/8/06)

5500 Forms Not Needed for Certain Plans (12/8/06)

Allowable Plan Reserves (12/8/06)

Allowable Plan Reserves (12/8/06)

Broker Income and Float Income Addressed in the Proposed Revisions to the 5500 Form (12/8/06)

Extremely important notice to doctors & hospitals to assure you get your money without unintended IRS withholding. (12/8/06)

Good News for Self-Funded Partners/S Corp (12/8/06)

IRS on HMOs (12/8/06)

New Internet Provider TIN Matching Program (12/8/06)

Reserves Reminder (12/8/06)

Section 419A reserve limits for funded welfare benefit plans (10/17/97)

Why VEBA Tax-exemption is Obsolete These Days (9/1/96)

1099 - IRS Letter (12/8/94)

IRS Issues VEBA Regs for Association Geographic Limits (9/1/92)

Official Source Documents

IRS FAQs on Medical Expenses Related to Nutrition, Wellness and General Health (8/11/23)

IRS Notice 2019-63 (12/2/19)

IRS - FAQs for Same Sex Couples (10/7/19)

TINs - Incorrect or Missing - IRS Publication 1586 (11/21/17)

HR 1304 (Exclude from the definition of health Insurance coverage certain Medical stop-loss insurance) (4/27/17)

IRS ACA Webpages (7/31/13)

IRS Notice 2013-8 - 2012 Transit Benefit Limit (1/18/13)

IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States (10/29/12)

2010 Excise Tax Requirements: Form 8928 (2/4/10)

2010 Excise Tax Requirements: Form 8928 Instructions (2/4/10)

IRS Notice on Debit Card Relief (12/15/06)

1099 - MISC Information Reporting Requirements (Final Regulation) (12/8/06)

Medicaid

Articles and Materials

Caution on Medicaid Information Sharing Requests (1/31/23)

CMS Letter to States (12/29/06)

Congress Requires States to Be More Aggressive in Demanding Plan Eligibility Files for Medicaid Recovery (12/8/06)

Letter to State Medicaid Directors on Medicaid Recovery - Ronnie Brown, Covenant Administrators, Inc. (12/8/06)

Medicaid Recovery Provision in the Deficit Reduction Act of 2005 (12/8/06)

State Medicaid Agencies Want TPA Eligibility Files (12/8/06)

State Medicaid Compliance (9/25/06)

Medicaid Recovery Initiatives: Markup of Title 19 - Prepared by Sue Knefley (CMS) (3/8/06)

Official Source Documents

State Medicaid Programs TPL Contact List April 2018 (2/2/23)

Medicaid Recovery FAQ from CMS (12/14/17)

CMS Cover Letter to Medicaid Directors (12/29/06)

CMS Qs and As on Medicaid Recovery (12/29/06)

Medicare

Articles and Materials

Refresher on Medicare as a Second Qualifying Event and COBRA (8/16/19)

Medicare Part D - Health Reform's Impact on Medicare Part D (4/27/10)

Designing Plans for Older Workers (5/23/08)

Data Elements under Consideration for the New Medicare Eligibility Sharing Rule (1/28/08)

Clarification: Additional Information on How to find an Actuary (12/8/06)

Client Handout: Quick Overview of Employer Notice Requirements (12/8/06)

CMS Clarifies Notification Deadlines (12/8/06)

CMS Clarifies Payment in HRAs (12/8/06)

Medicare - Calculating the Late Enrollment Penalty (12/8/06)

Medicare Part D Coverage Questions Persist (12/8/06)

Medicare Part D Questions Abound on Plan Design (12/8/06)

Medicare Regulations Clarify Medicare Part D Subsidy (12/8/06)

Medicare Wrap Arounds (12/8/06)

New Release About Medicare Prescriptions (12/8/06)

Retiree Drug Subsidy Applications: Important Reminders (12/8/06)

Medicare Part D - Employers, Unions and the MMA: Lessons Learned & Important Updates (9/25/06)

Medicare Part D Plan Sponsor Notice Deadlines (9/1/05)

Official Source Documents

Medicare Drug Price Negotiation: Selected Drugs for 2026 (9/7/23)

Medicare Part D: Updated guidance on Disclosure of Creditable Coverage (11/5/09)

Medicare for All

Articles and Materials

The Costs of a National Single-Payer Healthcare System (8/2/19)

Medicare Secondary Payer

Articles and Materials

SPBA Sends ESRD Comments to Congressional Leadership (12/1/22)

ESRD Legislation Introduced in House and Senate (9/2/22)

Medicare Secondary Payer Rules and Incentivizing Plan Participants to Join Medicare (1/3/20)

Medicare Secondary Payer Manual: Chapter 2 MSP Provisions (11/21/18)

MSP Mandatory Reporting Penalties (12/1/15)

MSP Reporting and HRAs (6/10/10)

CMS Posts Model Form for Soliciting SSNs (7/22/09)

MSP Mandatory Reporting User Guide, Version 2.0 (Article + User Guide) (1/5/09)

Implementation of Medicare Secondary Payer Mandatory Reporting Provisions (11/5/08)

Older Workers Declining the Group Plan Due to Medicare Coverage (12/14/07)

Official Source Documents

MSP ESRD Introduction by CMS (10/24/24)

GHP User Guide 2020 (8/7/20)

Support Act GHP Reporting Requirements: FAQs (1/3/20)

SSN Model Collection Form (3/4/11)

Alert on Obtaining SSNs (3/4/11)

MSP Mandatory Reporting User Guide - Version 3 (9/1/10)

Medicare Part D

Articles and Materials

CMS Medicare Part D (8/17/11)

Official Source Documents

Medicare Drug Price Negotiation: Selected Drugs for 2026 (9/7/23)

Mental Health Parity

Articles and Materials

ERIC Members Challenge Department of Labor’s MHPAEA Regulation (2/25/25)

DOL Office of Inspector General Survey on Mental Health Parity Enforcement (4/15/24)

Back to the Future: Mental Health Parity Audits (9/30/16)

Residential Treatment Exclusion Violates Mental Health Parity (2/29/16)

Consistency of Large Employer & Group Health Plan Benefits with Requirements of the Paul Wellstone & Pete Domenici MHP & Addiction Equity Act of 2008 (11/12/13)

New Mental Health Coverage Requirements of the Wellstone Act (8/31/09)

Official Source Documents

Final Rule: Mental Health Parity Act (11/12/13)

Mental Health Parity & Addiction Equity Act (MHPAEA)

Articles and Materials

Report to Congress on MHPAEA Released by Federal Agencies (2/27/25)

ERIC Members Challenge Department of Labor’s MHPAEA Regulation (2/25/25)

Tri-Agencies Release MHPAEA Regulations and Report to Congress (7/25/23)

SPBA Meets with Agencies on MHPAEA Compliance (12/14/22)

MHPAEA Provisions in CAA (2/2/21)

Agencies Solicit Comments on MHPAEA, Issue Model and FAQs (6/30/17)

Final Mental Health Parity & Addiction Equity Act (MHPAEA) Regulations (article) (11/12/13)

Consistency of Large Employer & Group Health Plan Benefits with Requirements of the Paul Wellstone & Pete Domenici MHP & Addiction Equity Act of 2008 (11/12/13)

New MHPAEA FAQs Released (5/10/12)

New Information on Mental Health Parity & Addiction Equity Act of 2008 Implementation (2/7/11)

DOL Gives Plans Clarification on MHPAEA (7/8/10)

Comments on MHPAEA Interim Final Regulations (5/4/10)

TPAs Don't Need to Inform Their Clients About These Things (3/4/10)

MHPAEA Interim Final Regulations (2/17/10)

MHPAEA Overview (2/16/10)

2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert) (2/2/10)

MHPAEA Regs Delayed Until January 2010 (10/3/09)

Effective Date of Mental Health Parity Addiction Equity Act (7/30/09)

Official Source Documents

Biden Administration Releases New MHPAEA Regulation (8/25/23)

DOL PPT on MHPAEA NQTL Comparative Analyses (5/27/22)

2021 MHPAEA Enforcement: Fact Sheet (1/26/22)

2022 MHPAEA Report to Congress (1/26/22)

Mental Health Parity (MHPAEA) Resource Materials for NQTLs (6/30/21)

DOL Issues New FAQs on Mental Health Parity and Substance Use Disorder Rules + Fact Sheet + Proposed FAQs + Documentation Request Form (5/1/18)

Parity of Mental Health & Substance Use Benefits with Other Benefits; Using Your Employer-Sponsored Health Plan to Cover Services (6/29/16)

Warning Signs-Plan or Policy Non-Quantitative Treatment Limitations that Require Additional Analysis to Determine MHP Compliance (6/29/16)

Final Rule: Mental Health Parity Act (11/12/13)

Understanding Implementation of the MHPAEA Act of 2008 - FAQs (5/10/12)

MHPAEA Interim Final Rules - Federal Register (2/2/10)

MHPAEA Request for Information (5/7/09)

Michelle's Law

Articles and Materials

Opt-Out from Michelle's Law (2/19/10)

Michelle’s Law: Questions Remain (2/19/10)

NAIC News

Articles and Materials

SPBA 2013 NAIC Press Release (12/16/13)

SPBA Talking Points for Letters on Stop-Loss Attachment Points (8/31/12)

SPBA Stop-Loss Issue Debated at NAIC Summer Convention (8/22/12)

SPBA Testifies at NAIC on Stop-Loss (8/13/12)

URGENT: Self-funding Challenged by NAIC (8/8/12)

Official Source Documents

Letter to Insurance Commissioners Providing a Transitional Policy for Individual & Small Group Market Policies (11/14/13)

Nondiscrimination - Section 1557

Articles and Materials

Final Regulations Regarding Section 1557 Nondiscrimination Rules Recently Released by U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) (6/26/24)

New Laws Enacted by the Consolidated Appropriations Act of 2023 (CAA23) (1/30/23)

HHS Centers for Medicare & Medicaid Services (CMS) Update Payment Parameters in 2023 Notice (7/5/22)

Christian Employers Case Section 1557 (7/5/22)

Official Source Documents

Background documents HHS ACA Section 1557 Nondiscrimination (6/26/24)

Section 1557 of the Patient Protection and Affordable Care Act (7/29/22)

Section 1557 Notice of Proposed Rulemaking (7/29/22)

Nondiscrimination - HIPAA/GINA

Articles and Materials

Self-Inflicted Injury Clauses in Health Plans (9/10/22)

Nondiscriminatory Wellness Programs in Group Health Coverage (12/18/19)

Genetic Nondiscrimination Act (6/6/08)

Beware of Designing Wellness Programs with Penalties Rather than Incentives (5/24/07)

Plan Checks ($) for Healthy Activities and the HIPAA Wellness Rule (5/21/07)

Plan Incentives for Healthy Behavior (5/11/07)

Rewards and Penalties for Disease Management Participation (5/11/07)

Article on HIPAA Nondiscrimination Final Rules (1/11/07)

May Plan Sponsors Reward Non-Smokers under the Health Plan? (12/8/06)

Reducing Benefits for Active Workers (10/26/05)

Official Source Documents

September 2009 GINA Regs (10/2/09)

Federal Register Notice on the Genetic Information Nondiscrimination Act (11/17/08)

Final Rules on HIPAA Nondiscrimination & Wellness Programs (1/11/07)

Nondiscrimination Rules - IRS

Articles and Materials

IRS Nondiscrimination Rules for Self-Funded Plans (12/10/24)

Nondiscrimination Issues: 105(h) and Issues Impacting Wellness Program; Ashley Gillihan (8/31/10)

Official Source Documents

IRS Nondiscrimination Rules for Self-Funded Plans (12/8/06)

Plan Assets

Articles and Materials

Plan Asset Regulations (1/24/24)

Portability - HIPAA

Articles and Materials

Special Enrollment Question and DOL Response (1/30/19)

Dependents Losing Coverage and HIPAA Special Enrollment Periods (3/23/07)

Lifetime Maximums and HIPAA Special Enrollment Periods (12/8/06)

Special Enrollment Period Change (12/8/06)

VA Coverage is Creditable Coverage (12/8/06)

Final HIPAA Portability Rules (1/18/05)

Official Source Documents

Final Rules HIPAA Portability 12/30/2004 (8/21/14)

Self-Compliance Tool for Part 7 of ERISA: HIPAA and Other Health Care-Related Provisions (3/26/13)

Model HIPAA Exemption Election for Non-Federal Governmental Plans (5/4/07)

Federal Register 2002: Non-Federal Governmental Opt-Out Requirements (12/8/06)

Federal Register 2004: Propsed Rules on Tolling Time Periods (12/8/06)

Prescription Drug Reporting (RxDC)

Prescription Drug and Healthcare Cost Reporting 10/25 @ 1PM ET (10/11/22)

Prescription Drug and Healthcare Spending (2/8/22)

Articles and Materials

House Subcommittee Holds Hearing to Examine Abusive PBM Practices (4/29/25)

PBM Executives Face Bipartisan Scrutiny at House Hearing (8/30/24)

CAA Prescription Drug Reporting Deadline is Looming (3/22/24)

CMS Releases Updated RxDC Reporting Instructions for the 2022 Reference Year (3/27/23)

CMS Releases Updated RxDC Reporting Instructions for the 2022 Reference Year (3/27/23)

Agencies Release Good Faith Relief on RxDC Reporting (12/27/22)

Agencies Release Interim final Rule - Prescription Drug and Health Care Spending (11/18/21)

TPA Client Newsletter: Agencies Release Interim Final Rule - Prescription Drug and Health Care Spending (11/18/21)

Official Source Documents

RxDC Reporting Instructions (2/27/23)

RxDC Interim Final Rule Text (2/27/23)

RxDC Reporting FAQs (2/27/23)

Webinar

Webinar: RxDC Reporting: What You Need To Know (5/1/24)

Prescription Drugs

FDA Guidance on Importing Drugs from Canada (6/10/22)

Emerging Issues for Prescription Drugs in 2021 (12/3/20)

Articles and Materials

Specialty Drug Section & Drug Importation in this Presentation (9/12/24)

PBM Executives Face Bipartisan Scrutiny at House Hearing (8/30/24)

President Signs Executive Orders on Prescription Drug Costs (7/27/20)

FDA issues Proposed Rules on Importing Prescription Drugs from Canada (12/31/19)

Administration Released Limited Prescription Drug Importation Proposal (12/30/19)

HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs (8/2/19)

Medicare-for-all!!! Happy talk that lets everyone mislead themselves. (1/30/19)

Off-Label & Non-Approved Drugs & Treatments (12/18/07)

Canada Issues: Importing Drugs - Canada Drug Warning (again) (Nov 2003) (12/8/06)

Privacy - GLBA

Articles and Materials

Gramm-Leach Bliley Act - New Financial Services Legislation (12/8/06)

Gramm-Leach-Bliley Act - Decision Tree and Sample Privacy Notice (12/8/06)

What TPAs Need to Know and Do about the Gramm-Leach-Bliley Act (12/8/06)

Same-Sex

Official Source Documents

Attorney General Lynch Announces Federal Marriage Benefits Available to Same-Sex Couples Nationwide (7/30/15)

Schedule J

Articles and Materials

DOL Annual Report to Congress on Self-funded Health Plans (4/27/17)

Executive Order Impact (1/31/17)

2016 Year in Review (12/29/16)

DOL 5500 Form and Schedule J (12/5/16)

DOL 5500 Form & Schedule J + Comment Letter (11/26/16)

Schedule J Proposed in New 5500 Regulations (10/27/16)

Official Source Documents

DOL Releases 2020 Annual Self-Insured Health Plan Report to Congress + Summaries (2/10/21)

2017 DOL Annual Report on Self-insured Group Health Plans (3/1/17)

Security - Cybersecurity and HIPAA

Articles and Materials

HIPAA Security Rule will Undergo Significant Revisions in 2025 (2/25/25)

New Security Risk Assessment Nov 2024 (12/16/24)

FTC Publishes Final Rule Updating the Health Breach Notification Rule (12/16/24)

FTC Publishes Final Rule Updating the Health Breach Notification Rule (6/26/24)

OCR issues Updated Guidance on HIPAA Requirements for the use of Online Tracking Technologies (3/29/24)

HHS Finalizes New Provisions to Enhance Integrated Care and Confidentiality for Patients with Substance Use Conditions (2/26/24)

Mitigate Cyber Attacks with Industry Standard Security Protocols (11/1/22)

2022 New Security Risk Assessment Tool (7/7/22)

Cyber Alert: Updates on Ransomware and Critical VMware Vulnerability (7/15/21)

OCR Issues Audit Report on Health Care Industry Compliance with the HIPAA Rules (12/30/20)

HHS OCR Clarifies Direct HIPAA Liability of Business Associates (6/7/19)

NAIC Adopts Cybersecurity Model Law (11/28/17)

US CERT ALERT: Malware Infecting U.S. Businesses (11/17/17)

HHS Update: International Cyber Threat to Healthcare Organizations -- (5/15/17)

Great Ideas From Fall Meeting Sessions on Cyber Security (10/28/16)

Sharing Patient Data Subject to FTC Regulations, Not Just HIPAA (10/28/16)

UPDATED: Security Risk Assessment (SRA) Tool (9/30/16)

Protecting HIPAA Private Health Information (6/29/16)

Cybersecurity: Ransomware & Recent Variants (6/1/16)

OCR Cyber-Awareness Update (6/1/16)

Security Alert Updates from OCR, US-Cert and the FBI (5/6/16)

DHS Cyber Alert on Ransomware (4/6/16)

Cybersecurity Act of 2015 (1/29/16)

Security Update: Business Associates are a Priority (12/30/15)

HHS Releases Final HIPAA Rule (1/24/13)

OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol FROM OCR’s EMAIL ALERT June 26, 2012 (7/17/12)

HHS Issues Breach Notification Rules (9/10/09)

HHS Breach Notification Rules (9/8/09)

HIPAA Security Rules: Overview (12/8/06)

Implementing the HIPAA Security Standards for Group Health Plans - Amending Plan Documents (12/8/06)

Security Business Associate Addendum Memo (12/8/06)

HIPAA Security Compliance Strategies - Mariann Yeager, MBA, TruArx, Inc. (5/2/05)

HIPAA Security Standards Addendum (10/26/04)

Security Plan Document Amendment (10/16/04)

Official Source Documents

HIPAA Security Rule to Strengthen the Cybersecurity of ePHI NPRM (1/3/25)

HHS Office for Civil Rights Creates FAQ Webpage in Response to the Change Healthcare Cyberattack (4/22/24)

OCR Cybersecurity Newsletter: Defending Against Common Cyber-Attacks (4/28/22)

Controlling Access to ePHI: For Whose Eyes Only? (7/15/21)

2016 - 2017 HIPAA Audits Industry Report (12/21/20)

How to Manage Malicious Insider Cyber Threats (8/30/19)

Risk Analyses vs. Gap Analyses – What is the difference? (6/29/18)

HHS OCR Cybersecurity December Newsletter (12/28/17)

OCR Cybersecurity Newsletter: Insider Threats and Termination Procedures (12/1/17)

OCR April Cybersecurity Newsletter - Man in the Middle Attacks and more (4/27/17)

Reporting and Monitoring Cyber Threats (2/28/17)

HIPAA Audit Phase 2 (11/30/16)

Additional Clarification Regarding Phishing Email Alert Audits of Business Associates Are Underway (11/30/16)

Identifying DDOS Risks to ICS Environments (10/28/16)

Cyber Threat Information-Sharing (9/30/16)

HIPAA Audits Are Coming to Business Associates - NOW (9/30/16)

HIPAA Audit Protocol 2016 (9/22/16)

OCR Announces Initiative to More Widely Investigate Breaches Affecting Fewer than 500 Individuals (8/30/16)

Do You Know Who Your Employees Are? (8/30/16)

Cyber Incident Reporting: A Unified Message for Reporting to the Federal Government (8/30/16)

New HIPAA Ransomeware Guidance: Fact Sheet (7/21/16)

HHS office of OCR has issued Awareness Newsletter on Responding to Cybersecurity Incidents. (7/21/16)

OCR Releases HIPAA Phase 2 Audit Protocols (4/8/16)

HIPAA Security Rule Crosswalk to NIST Cybersecurity Freamework (2/29/16)

NIST Cybersecurity Framework (1/28/16)

HIPAA Security Guidance for Remote Use of Electronic Health Information (2/26/07)

Specialty Drugs

Articles and Materials

B & C. Compliance Update I. Ashley Gillihan, Alston & Bird (9/24/24)

Specialty Drug Section & Drug Importation in this Presentation (9/12/24)

Specialty Drugs and Plan Design: Strategies and Compliance Issues (5/4/20)

Specialty Drug Webinar on Legal Challenges in Designing Plans - July 2016 (11/10/16)

State Licensing

Articles and Materials

2024 SPBA Third Party Administrator State Licensing Statutes as of April 2024 (4/17/24)

2022 TPA License Corrections (10/11/22)

TPA License Change For Michigan (7/5/22)

Official Source Documents

Kansas TPA Act; SB22 (4/27/17)

Indiana Department of Insurance: Bulletin 236 - Nonresident TPA Licensing (4/27/17)

States

Articles and Materials

Alabama: Notice of Regulation Hearing on PBMs (10/10/19)

California Standing Strong to Fight Surprise Billing (9/11/19)

Nevada: Revised Statutes - Third Party Parental Guaranty & Notification Requirement (10/25/17)

Arkansas: TPA License Survey 2017 Corrections (10/24/17)

Nevada: Revised Statutes (10/24/17)

Minnesota Stop-Loss (2/1/17)

Texas Prompt-Pay Law (2/29/16)

Washington State TPA Legislation Update + Original Article from January's UPDATE (2/17/16)

Washington State TPA Legislation + Link to Bill (1/29/16)

Michigan: Determining Which Entity Must Pay (5/1/12)

Georgia - OCGA § 33-30-13.1 (11/5/08)

Indiana & Maine (11/5/08)

Iowa - 509.19 Claims & Premium Disclosure (11/5/08)

Kentucky 806 (pdf) (11/5/08)

Kentucky 846 (11/5/08)

New Mexico (11/5/08)

Oklahoma - Section 4512 (11/5/08)

South Dakota (11/5/08)

State Survey of Insurer Claims Data: Florida - 2007 Florida Statutes (11/5/08)

Texas - HB 2015 Amended (11/5/08)

Texas - HB 2015 Enrolled Version (11/5/08)

Virginia (11/5/08)

Wisconsin (pdf) (11/5/08)

Bill Number: TX80RHB 2015 (10/11/07)

Massachusetts Health Care Reform (10/11/07)

New Transparency Legislation in Texas for Health Care Plans (10/11/07)

State Health Care Reform (10/11/07)

Texas Loss Experience Legislation (10/11/07)

The 2007 Texas Legislative Session - Sam Francis, JI Companies (10/11/07)

Additional Questions on the NYHCRA (12/8/06)

Mississippi Starting Surcharge Applies to Insurers, Stop-loss + some TPA situations (12/8/06)

New State Surcharge Nicks Employer Health Plans (12/8/06)

New York Surcharge Impacts Employers (12/8/06)

NJ Law Turns Lemons to Lemonade (12/8/06)

Questions and Answers about the New York Health Care Act (12/8/06)

State TPAs: Together you stand. Divided you fall. (12/8/06)

Strategies on Massachusetts (12/8/06)

Third Party Administrator Statute (12/8/06)

Massachusetts Health Care Reform - James Stirling, Stirling Benefits (9/25/06)

State Legislatures Hurt Insurance Companies & Policyholders (11/2/02)

Frequently Asked Questions on the New York State's Health Care Reform Act (11/22/96)

Official Source Documents

Massachusetts: Health Insurance Responsibility Disclosure (HIRD) Frequently Asked Questions (11/5/18)

North Carolina: North Carolina General Assembly Conference Report (House Bill 649) (8/1/13)

Connecticut: Childhood Immunization Vaccine Assessment (8/1/13)

North Carolina General Assembly Conference Report (7/29/13)

Stop-Loss

Articles and Materials

Minnesota Stop-Loss (2/1/17)

NAIC White Paper: Stop-Loss & Self-Funding (Attached: White Paper: Stop-Loss Insurance, Self-Funding & ACA) (8/13/14)

SPBA Talking Points for Letters on Stop-Loss Attachment Points (8/31/12)

Answers to Request for Information about Stop-Loss (5/2/12)

Official Source Documents

State of Connecticut Stop Loss Insurance Coverage (Bulletin HC-108 & PC-80) (12/30/15)

White Paper: Stop-Loss Insurance, Self-Funding & ACA (8/13/14)

Subrogation

Articles and Materials

Subrogation News: Sereboff - What the Plan Did Right (12/8/06)

Supreme Court Case: Sereboff (12/8/06)

Surprise Billing (see Transparency/Surprise Billing Resource Center on the homepage)

No Surprises Act - First Set of New Regulations (Webinar) (7/20/21)

Articles and Materials

No Surprises Act – Determining Cost-Sharing and Payment Amounts to Providers (12/13/24)

SPBA Reviews the Administration's Executive Order (7/15/21)

Future Rollout of Federal Guidance Planned (7/7/21)

Administration Releases Interim Final Rule on the No Surprises Act (7/2/21)

Advanced Explanation of Benefits in the No Surprises Act (5/28/21)

SPBA Submits Comments on No Surprises Act Regulations (5/26/21)

F. New Federal No Surprises Act & Related Transparency Requirements (4/7/21)

End of Year Spending and COVID Stimulus Package: A Summary (2/4/21)

No Surprises Act - Section by Section Summary (2/4/21)

Official Source Documents

Surprise Billing Model Notice (10/18/21)

Requirements Related to Surprise Billing; Part II - IFR (Fact Sheet) (10/4/21)

Requirements Related to Surprise Billing; Part II pdf (Federal Register IFR) (10/4/21)

No Surprises Act Bill Text (2/4/21)

Transgender

Articles and Materials

District Court Injunction on ACA Section 1557 (1/5/17)

USERRA/Veterans

Articles and Materials

Veterans Affairs Requests Electronic Remittances (6/16/09)

Legislation Benefits for Military Personnel (Heroes or Heart Act) (6/27/08)

USERRA Final Regulations: Overview (12/8/06)

USERRA: Veterans Benefits Improvement Act of 2004 (12/8/06)

USERRA Final Regulations Wm. Kenan Torrans, DOL (5/3/06)

USERRA Overview - William Kenan Torrans, DOL VETS (5/19/05)

USERRA: Military Mobilization Impacts Employer Plans (1/1/03)

New Veterans Rights Law Highlights Employer Responsibilities (12/2/95)

Employee Benefit Impact of the Mobilization of Military Reserves for Operation Desert Shield and Operation Desert Storm (1/15/90)

Official Source Documents

USERRA: Final Regulations (12/8/06)

Value Driven Initiatives

Articles and Materials

Be Prepared for Client Question on Value-Driven (5/4/07)

Purchaser Guide for Employers on Value-Driven Health Care (2/8/07)

Wellness

Articles and Materials

EEOC Proposes New Wellness Regulations (2/2/21)

Judge Dismisses Challenge to Wellness Program (8/15/19)

Wellness Final Rules under ADA Title I (7/22/16)

Proposed EEOC Regulation - Application to GINA Title II to Wellness Programs (PPT 12-17-15) (3/16/16)

Incentives in Employer Wellness Programs for Employees' Spouses to Provide their Current or Past Health Status Information (12/1/15)

SPBA Comments to EEOC on Proposed Wellness Rule (6/19/15)

EEOC Wellness Proposed Rule Article (4/28/15)

EEOC Fails to Resolve Wellness Issues in Final GINA Title II (12-21-10) (12/21/10)

Wellness - Developing as a Strategy (11/16/09)

EEOC Informal Letter on Health Risk Assessments (6/26/09)

Family Medical History Questions Problematic in Wellness Programs (5/20/09)

TPA Success in Wellness (11/5/08)

NCQA Releases Proposed Standards to Evaluate Health Promotion Programs (7/8/08)

Wellness Education Program (10/22/07)

Characteristics of Successful, Low Cost Wellness Programs (10/11/07)

Journal: Characteristics of Successful Wellness Programs (10/11/07)

Wellness Wizard - Determine Your Employee Health Risks, Costs, and Savings (10/11/07)

Beware of Designing Wellness Programs with Penalties Rather than Incentives (5/24/07)

Plan Checks ($) for Healthy Activities and the HIPAA Wellness Rule (5/21/07)

Plan Incentives for Healthy Behavior (5/11/07)

Rewards and Penalties for Disease Management Participation (5/11/07)

May Plan Sponsors Reward Non-Smokers under the Health Plan? (12/8/06)

Non-Plan Incentives for Healthy Behavior (Part 2), Howard Bard, Slevin & Hart, P.C. (ppt) (5/3/06)

Privacy Considerations in Connection with Initiatives for Healthy Behavior & the HIPAA Enforcement Rule (5/3/06)

Official Source Documents

Sample Notice for Employer-Sponsored Wellness Programs (7/22/16)

Q&As: Sample Notice for Employees Regarding Employer Wellness Programs (7/22/16)

Wellness Final Rules under ADA Title I - Federal Register (7/22/16)

HIPAA 2015 Privacy & Security Wellness Q&A (4/28/15)

EEOC Fact Sheet 2015 - Wellness Fact Sheet for Small Business (4/28/15)

Press Release 2015: EEOC Wellness Proposed Rule (4/28/15)

Federal Register: 2015 EEOC Wellness Proposed Rule (4/28/15)

Q&As on EEOC's Notice of Proposed Rulemaking on Employer Wellness Programs (4/18/15)

HIPAA Nondiscriminatory Wellness Programs: Final Regulation (5/30/13)

Webinar

Webinar: An Overview of Wellness Rules Governing Health Plans (10/2/23)