The Phia Group's Podcast

In his third State of the Union address, President Biden touted his administration’s record and outlined the issues he and his team will likely be campaigning on heavily as the 2024 presidential race kicks off in earnest. Sprinkled throughout were a number of policy wish list items, including some key healthcare initiatives that we’ll be keeping a close eye on in the coming months. Attorney’s Brady Bizarro and Nick Bonds bring you some of the highlights in this episode of the Empowering Plans podcast.  

The DOL recently issued new guidance on the long-standing contraceptive coverage mandate, and this time they took a different approach. Instead of clarifying prior guidance or issuing novel interpretations of the law, the DOL is giving health plans an alternative way to comply with the contraceptive coverage mandate: either follow the prior guidance issued in 2022… or don’t! The DOL introduced the “therapeutic equivalence” approach, whereby plans can comply with the law in a different, potentially less-burdensome way. Join The Phia Group’s Kendall Jackson and Jon Jablon as they discuss this “therapeutic equivalence” approach to compliance, what it means for consumers, and what it means for health plans.

Attorneys Andrew Silverio and Cindy Merrell discuss a newly decided case which provides a roadmap for pursuing settlement funds after disbursement. Who has the burden of proof when the funds have been dissipated? What is lowest intermediate balance rule? 

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara discuss the legal doctrine involved in two cases now before the Supreme Court – Chevron deference. They’ll explain what it means, why it is important for federal agency action, and how it impacts the entire healthcare industry. With a decision expected by this summer, you do not want to miss our take on how the NSA, the Medicare drug price negotiations, and the ACA itself could be at stake.

One might think they’re listening to a broken record when hearing Jennifer McCormick and Kelly Dempsey discuss the ever-shifting landscape of the Mental Health Parity and Addiction Equity Act (MHPAEA), but alas, this is a brand new podcast! As we start 2024, we are reframing our mindset and are making some changes to address the evolving MHPAEA regulations and insights we have received from regulating bodies through the NQTL Comparative Analysis Process. In addition to highlighting the significance of how these issues should be addressed within an employer’s PD/SPD, there are three main changes discussed to create visibility for employers creating new 2024 PD/SPDs.

The trend of provider consolidation is primed to pick up pace in 2024, distilling some areas into ever more highly concentrated healthcare markets. Ron Peck and Nick Bonds break down how this concentration impacts the costs of healthcare and can drive costs upward for employers and employees alike. With fewer provider options, higher prices, and patients caught in the middle, Ron and Nick outline just a few of their concerns and discuss some of the tools health plans have at their disposal.

It is the last podcast of the year, and you know All Too Well that it is Phia’s 2023 year-in-review! Sparks Fly as Kendall Jackson and Corey Crigger talk about how Everything in PGC and Provider Relations Has Changed in 2023. If you need to catch up on anything from the No Surprises Act to Gag Clause Attestations, You Need To Calm Down and Stay Stay Stay tuned into this podcast episode. In addition to the big changes in 2023, we look forward to 2024 and ask, are you … Ready For It?  

Attorneys Jon Jablon and Cindy Merrell discuss the practice of cross-plan offsetting and the recent settlement between the Department of Labor and EmblemHealth Inc. Who wins and who loses when a TPA decides to use cross-plan offset?   

Attorneys Brady Bizarro and Andrew Silverio discuss a recent federal court decision that saw drug manufacturers and patients alike score a win against copay accumulator programs – programs that help maximize the manufacturer assistance available to patients but decline to count those amounts toward deductibles and out-of-pocket maximums.  With the latest rule being struck down, where does the law stand now and what will happen next?

Join Provider Relations Senior Attorney, Brian O’Hara, and Vice President of Consulting, Kelly Dempsey, for a quick rundown of changes to be prepared for as we near 2024. While there are the regular recurring changes to ACA and IRS out-of-pocket limits, this podcast will uncover a couple lesser-known items hidden in some NSA proposed rules and a couple other items for 2024 that might have fallen off the radar, including COVID-19 tolling requirements. (COVID may be over but the impact on certain items could extend well into 2024…).