Supreme Court Decision Supports Group Health Plans Cost-Containment Strategies for Dialysis Payments
On June 21, 2022, the U.S. Supreme Court found in favor of the group health plan in the case of DaVita v. Marietta Hospital, finding that the Marietta Hospital Employee Health Benefit Plan did not violate the Medicare Secondary Payer Act (MSPA) in limiting dialysis payments to DaVita.
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MHPAEA Proposed Rules
On July 25, 2023, the U.S. Departments of Health and Human Services, Labor and Treasury issued Mental Health Parity and Addiction Equity Act (MHPAEA) proposed regulations and a Technical Release that seek to increase patient access and coverage for mental health and substance use disorder (MH / SUD) services, in parity with medical and surgical (M / S) services. The Departments also released the second annual MHPAEA Report to Congress.
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Gag Clause Prohibition Compliance Attestation
The Consolidated Appropriations Act (CAA), 2021, requires group health plans and health insurance issuers to annually complete a Gag Clause Prohibition Compliance Attestation (GCPCA), and the first attestation is due December 31, 2023.
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COVID-19 Emergencies to End
The COVID-19 National Health Emergency and Public Health Emergency (PHE) were to expire on March 1 and April 11, 2023, respectively. The Biden Administration is extending the expiration date to May 11, 2023, to align with its commitment to give a minimum of 60 days' notice prior to the end of the emergencies. Group health plans and issuers are studying what this means for medical plan related coverages and processes.
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Federal Legislation for Self-Funded Health Plans
WebTPA is committed to keeping its clients up to date on federal healthcare policies and legislation. Here you will find our interpretation of said legislation and how these statutes may impact your health plan.
Publicly Available, Machine-Readable Files
In-Network Rates and Historical Out-of-Network Allowed Amounts
To meet transparency requirements effective July 1, 2022, WebTPA will assist plan sponsors in making the two machine-readable files available (in-network rates for covered services or item covered by the plan, historical billed charges from out-of-network providers and the allowable amount of such charges considered by the plan).
Important Note
These are very large JavaScript Open Notation (JSON) files (20GB to 70GB) that may take a while to download. If your system has limited capability, they may not be downloadable. Download speeds and time are dependent on your internet speed, browser and computer hardware.
