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Course Details

Course Information
  • smart_display Format

    On-Demand

  • signal_cellular_alt Difficulty Level

    Intermediate

  • work Practice Area

    ERISA

Date & Time
  • event Date

    Wednesday, June 21, 2023

  • schedule Time

    1:00 p.m. ET./10:00 a.m. PT

  • timer Program Length

    90 minutes

Credit Information

  • This 90-minute webinar is eligible in most states for 1.5 CLE credits.

$347.00
CLE
ALL

This CLE webinar will provide employee benefits counsel and health plan sponsors an in-depth analysis of the recent court ruling in Braidwood Management v. Becerra regarding preventive care requirements under the Affordable Care Act (ACA). The panel will discuss recent litigation challenging the preventive care services requirements under the ACA, the impact on preventive services for private health plans, Medicare, and Medicaid, and next steps for counsel and plan sponsors.

Faculty

Steven D. Hamilton
Partner
Reed Smith

Mr. Hamilton is an seasoned trial lawyer who focuses his practice on healthcare litigation and regulatory issues. As an experienced trial attorney, he has managed and directly handled all aspects of cases, including first and second chairing multiple trials and arbitration hearings, as well as appellate briefs and arguments.

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Alexandra M. Lucas
Partner
Reed Smith

Ms. Lucas has broad experience in healthcare compliance and regulatory issues. She frequently advises health plans across the country on compliance with the Consolidated Appropriations Act of 2021 (CAA), the Affordable Care Act (ACA), and government program rules. Ms. Lucas has experience in specific compliance issues involving Medicare Advantage Plans, Medicaid Managed Care Organizations, Marketplace products, and Employee Retirement Income Security Act (ERISA) plans and administrators. She has represented health plans in litigation and arbitration, including in matters relating to ERISA and government program compliance, contractual payment disputes with hospital systems and providers, and high volume claim disputes with out-of-network providers. She is also passionate about legal technology and develops innovative, cost-saving legal products using artificial intelligence, document automation, and knowledge management tools.

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Description

In response to the recent federal district court decision in Braidwood Management. v. Becerra, the Departments of Labor, Treasury, and Health and Human Services issued guidance for group health plans on required preventive services coverage. The court ruling significantly impacts the ACA preventive care services mandate for health plans and counsel and plan sponsors must review plan documents and coverages in light of the court ruling and recent guidance.

The ACA requires private health insurance plans to cover a range of recommended preventive services without any patient cost-sharing. These preventive services include screening tests, immunizations, behavioral counseling, and medications that can prevent the development or worsening of health conditions.

Prior to the Braidwood decision, the ACA required non-grandfathered group health plans and issuers to cover certain preventive services and items without participant cost-sharing when provided in-network. Now, the court ruling essentially removes the preventive services mandate for certain categories. The court decision applies only to recommended items and services with an "A" or "B" rating by the United States Preventive Services Task Force on or after Mar. 23, 2010, with all other preventive care requirements remaining in place.

Listen as our panel discusses recent litigation challenging the preventive care services requirements under the ACA, the impact on preventive services for private health plans, Medicare, and Medicaid, as well as next steps for counsel and plan sponsors.

Outline

  1. ACA preventive services requirements
  2. Analysis of Braidwood Management v. Becerra
  3. Issues for coverage and access in private health insurance
  4. Challenges for access in Medicaid and Medicare
  5. Next steps for counsel, plan sponsors, and administrators

Benefits

The panel will discuss these and other key issues:

  • What are the ACA requirements for preventive services?
  • What impact does the Braidwood decision have on health plan design and administration?
  • What categories of preventive services are impacted?
  • What are the implications for coverage and access to preventive services in private health insurance?
  • What are the implications for access to preventive services in Medicaid and Medicare?