Nothing written by SPBA is legal advice.
ACA Replace Legislation and Papers
Official Source Documents
Access/Protection
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)
Articles and Materials
AHP (Association Health Plans)
AHP Comment Letter on Behalf of SPBA (8/15/19)
Official Source Documents
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 Letter to Senate (8/8/18)
Americans with Disabilities Act
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)
Cafeteria Plans
Articles and Materials
Cafeteria Plans - Agency Guidance
Official Source Documents
2015 Health FSA Dollar Limits (11/15/14)
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)
Debit Card IRS Revenue Ruling (12/8/06)
Cafeteria Plans - Explanation and Commentary
Articles and Materials
$2,500 Health FSA Limit Guidance (7/17/12)
5500 Forms and Cafeteria Plans (12/8/11)
Cafeteria Plan Elections (11/16/09)
New Proposed Cafeteria Plan Regulations (1/23/08)
Cafeteria Plan Election Changes (12/8/06)
Debit Cards (10/24/06)
CHIPRA
Employer CHIP Notices (8/15/19)
CHIP DOL Release (8/15/19)
Model CHIP Notice (2/4/10)
CHIPRA Notice Requirements (4/27/09)
COBRA
Official Source Documents
1999 and 2001 Final COBRA Regs (8/16/09)
Articles and Materials
FAQ 32 COBRA (8/15/19)
FAQ 32 COBRA (6/29/16)
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)
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)
Gillihan's COBRA Presentation (11/3/05)
COBRA-ARRA
COBRA Model Notices (8/16/19)
COBRA Subsidy Extension (2/24/10)
COBRA Subsidy Extension Signed into Law (12/28/09)
Frequent ARRA COBRA Subsidy Questions (7/30/09)
CMS COBRA Denial Application (5/8/09)
DOL COBRA Denial Application (5/8/09)
COBRA Expanded for TAA Individuals (4/27/09)
ARRA COBRA Subsidy: Phase II (4/16/09)
ARRA Second Chance Election (4/9/09)
COBRA Premium Update (2/23/09)
Defense of Marriage Act (DOMA)
Supreme Court Decides DOMA (8/17/19)
DOL News Release: New Guidance Issued by the DOL on Same-sex marriages & Employee Benefit Plans (8/16/19)
U.S. v. Windsor: A CMS Update (10/4/13)
U.S. v. Windsor: DOMA Opinion (6/26/13)
U.S. v. Windsor (11/1/12)
Official Source Documents
Disclosure of Fees
Domestic Partners
IRS - FAQs for Same Sex Couples (10/7/19)
U.S. v. Windsor (11/1/12)
DOL
Articles and Materials
DOL Makes Claims Records Relevant (7/15/21)
Claim Regulations Raises Fees Issue (12/8/06)
Official Source Documents
Comprehensive Guidance on the DOL Claims (10/7/19)
DOL Proposed Rule on TPA Fee Disclosure (10/7/19)
DOL Releases Plan Asset Regulations (10/7/19)
DOL Disclosure Rules (4/6/09)
New SPD Requirements Under HIPAA (12/8/06)
EDI/Interoperability
Official Source Documents
CMS-AMA ICD-10 Flexibilities Statement (7/29/15)
ICD-10 - Testing with CMS (7/29/15)
CMS Announces Contingency Plan on NPI (4/27/07)
Federal Register 2005 Proposed Rules HIPAA Standards for Electronic Health Care Claims Attachments (12/8/06)
Articles and Materials
ICD-10 Stop-Loss Disclosure Trigger List (9/23/15)
ICD-10 Stop-Loss Disclosure Paper (9/15/15)
HHS Provides Feedback on NPI (12/8/06)
Kansas Terminates Digital Healthcare (12/8/06)
TPA Websites for Providers and EDI (12/8/06)
EEOC
Articles and Materials
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)
Official Source Documents
5500 Forms
Official Source Documents
Delinquent Filer Correction Program (2/8/21)
Articles and Materials
DOL 5500 Form & Schedule J + Comment Letter (11/26/16)
FMLA (Family Medical Leave Act)
FTC (Federal Trade Commission)
Health Reimbursement Arrangements
Official Source Documents
HRA - IRS Notice 2002-45 (12/8/06)
HRA - IRS Revenue Ruling 2002-41 (12/8/06)
Administration Finalizes New HRA Rule (6/14/19)
Articles and Materials
CMS Clarifies Payment in HRAs (12/8/06)
Health Savings Accounts
Articles and Materials
IRS Expands Preventative Care Benefits Permitted to be Provided under a High Deductible Health Plan (1/3/20)
IRS Retirement Plan News (10/1/09)
HSA Contribution Limits for 2020 (1/3/20)
HSA 2018 Contribution Limits (4/24/18)
HSA Comparability Rule: A Legal but Practical Perspective - Ashley Gillihan, Alston & Bird, LLP (4/17/07)
All About HSAs (12/8/06)
FSA Interaction with HSAs (12/8/06)
Health Savings Accounts - First Analysis (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)
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)
Official Source Documents
2018 HSA Inflation - Adjusted Amounts (6/30/17)
IRS Notice 2004-2 (11/14/14)
IRS Notice 2004-50 (7/30/10)
Custodial Account Form (7/10/08)
DOL FAB 2004-01 (12/8/06)
DOL FAB 2006-02 (12/8/06)
Final HSA Comparability Rules (12/8/06)
Treasury Guidance on Preventive Care (1/19/06)
Notice 2005-8 - 2% Shareholders (8/5/05)
HIPAA Opt Out
HIPAA and Privacy
Articles and Materials
HIPAA Privacy Opioid Guidance (11/28/17)
New HIPAA Business Associate Agreements (8/27/14)
Revised 2013 Notice of Privacy Practices (8/15/13)
Business Associate Agreement & Preventive Contraceptive Services and Self-Insured Religious Plans (4/17/13)
HHS Releases Final HIPAA Rule (1/24/13)
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)
Complaint Sample Form (12/8/06)
Does HIPAA Privacy prohibit insurers or HMOs from releasing claims experience due to HIPAA Privacy? (12/8/06)
Flowchart Brainstorming Tools (12/8/06)
HIPAA PRIVACY: Overview for TPAs (12/8/06)
Memo Explaining HIPAA Privacy Documents (12/8/06)
Providers Misinterpreting HIPAA Privacy (12/8/06)
Sample Amendment to Plan Documents (12/8/06)
The HIPAA Security Standards: Practical Implementation Considerations - Dorthula Powell-Woodson (5/2/05)
Official Source Documents
HIPAA Audit Protocol 2016 (9/22/16)
HIPAA Privacy in Emergency Situations (11/18/14)
HIPAA Security Guidance - HHS (4/17/07)
IRS
Articles and Materials
Official Source Documents
IRS Notice 2019-63 (12/2/19)
IRS ACA Webpages (7/31/13)
IRS - FAQs for Same Sex Couples (10/7/19)
IRS -FAQs for Registered Domestic Parters & Same-Sex Spouses in Community Property States (10/29/12)
2010 Excise Tax Requirements (2/2/10)
2010 Excise Tax Requirements + MHPAEA Interim Final Regs Released February 2, 2010 (Email Alert) (2/2/10)
Congress Reworks Dependent Definition (6/26/07)
1099 - IRS IIR Request (1/26/07)
IRS Issues Debit Card Transition Relief (12/15/06)
IRS Notice on Debit Card 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)
Home Exercise Equipment for Obesity (12/8/06)
IRS on HMOs (12/8/06)
Proposed Revisions to the 5500 Form (12/8/06)
Reserves Reminder (12/8/06)
1099 - IRS Letter (12/8/94)
Medicaid
Articles and Materials
Official Source Documents
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)
CMS Letter to States (12/29/06)
State Medicaid Compliance (9/25/06)
Medicare
Designing Plans for Older Workers (5/23/08)
CMS Clarifies Notification Deadlines (12/8/06)
Medicare Wrap Arounds (12/8/06)
New Release About Medicare Prescriptions (12/8/06)
Articles and Materials
CMS Clarifies Payment in HRAs (12/8/06)
Medicare for All
Articles and Materials
Medicare Secondary Payer
Official Source Documents
GHP User Guide 2020 (8/7/20)
SSN Model Collection Form (3/4/11)
Alert on Obtaining SSNs (3/4/11)
Articles and Materials
MSP Mandatory Reporting Penalties (12/1/15)
CMS Posts Model Form for Soliciting SSNs (7/22/09)
MSP Reporting and HRAs (6/10/10)
Medicare Part D
CMS Medicare Part D (8/17/11)
Mental Health Parity
Articles and Materials
Final Rule: Mental Health Parity Act (11/12/13)
Mental Health Parity & Addiction Equity Act (MHPAEA)
Official Source Documents
2021 MHPAEA Enforcement: Fact Sheet (1/26/22)
2022 MHPAEA Report to Congress (1/26/22)
Articles and Materials
MHPAEA Provisions in CAA (2/2/21)
Final Rule: Mental Health Parity Act (11/12/13)
New MHPAEA FAQs Released (5/10/12)
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)
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)
Official Source Documents
SPBA Testifies at NAIC on Stop-Loss (8/13/12)
Nondiscrimination - HIPAA/GINA
Articles and Materials
September 2009 GINA Regs (10/2/09)
Genetic Nondiscrimination Act (6/6/08)
Plan Incentives for Healthy Behavior (5/11/07)
Reducing Benefits for Active Workers (10/26/05)
Nondiscrimination Rules - IRS
Articles and Materials
Official Source Documents
Portability - HIPAA
Articles and Materials
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)
Prescription Drugs
HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs (8/2/19)
Off-Label & Non-Approved Drugs & Treatments (12/18/07)
Privacy - GLBA
Articles and Materials
Same-Sex
Official Source Documents
Security - Cybersecurity and HIPAA
Official Source Documents
2016 - 2017 HIPAA Audits Industry Report (12/21/20)
HHS OCR Cybersecurity December Newsletter (12/28/17)
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 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)
HHS office of OCR has issued Awareness Newsletter on Responding to Cybersecurity Incidents. (7/21/16)
NIST Cybersecurity Framework (1/28/16)
Articles and Materials
NAIC Adopts Cybersecurity Model Law (11/28/17)
OCR Cyber-Awareness Update (6/1/16)
DHS Cyber Alert on Ransomware (4/6/16)
Cybersecurity Act of 2015 (1/29/16)
HHS Releases Final HIPAA Rule (1/24/13)
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)
HIPAA Security Standards Addendum (10/26/04)
Security Plan Document Amendment (10/16/04)
Schedule J
Official Source Documents
Articles and Materials
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)
Specialty Drugs
Articles and Materials
State Licensing
Official Source Documents
Kansas TPA Act; SB22 (4/27/17)
States
Articles and Materials
Texas Prompt-Pay Law (2/29/16)
Official Source Documents
Massachusetts: Health Insurance Responsibility Disclosure (HIRD) Frequently Asked Questions (11/5/18)
Nevada: Revised Statutes (10/24/17)
Minnesota Stop-Loss (2/1/17)
Georgia - OCGA § 33-30-13.1 (11/5/08)
Indiana & Maine (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)
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)
State Health Care Reform (10/11/07)
Texas Loss Experience Legislation (10/11/07)
Additional Questions on the NYHCRA (12/8/06)
New York Surcharge Impacts Employers (12/8/06)
NJ Law Turns Lemons to Lemonade (12/8/06)
Strategies on Massachusetts (12/8/06)
Third Party Administrator Statute (12/8/06)
Stop-Loss
Subrogation
Articles and Materials
Supreme Court Case: Sereboff (12/8/06)
Surprise Billing
Articles and Materials
Official Source Documents
Surprise Billing Model Notice (10/18/21)
No Surprises Act Bill Text (2/4/21)
Transgender
Articles and Materials
USERRA/Veterans
USERRA Final Regulations: Overview (12/8/06)
USERRA: Final Regulations (12/8/06)
Articles and Materials
Value Driven Initiatives
Articles and Materials
Wellness
Articles and Materials
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)
EEOC Wellness Proposed Rule Article (4/28/15)
Wellness - Developing as a Strategy (11/16/09)
TPA Success in Wellness (11/5/08)
Wellness Education Program (10/22/07)
Plan Incentives for Healthy Behavior (5/11/07)