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Text of Letter from HHS to Rep. McDermott on Whether QHPs Are 'Federal Health Care Programs' (PDF)

"The Department of Health and Human Services does not consider QHPs, other programs related to the Federally-facilitated Marketplace, and other programs under Title I of the Affordable Care Act to be federal health care programs [under section 1128B of the Social Security Act, sometimes called the "Anti-Kickback Statute"]. This includes the State-based and Federally-facilitated Marketplaces; the cost-sharing reductions and advance payments of the premium tax credit; Navigators for the Federally-facilitated Marketplaces and other federally funded consumer assistance programs; consumer-oriented and operated health insurance plans; and the risk adjustment, reinsurance, and risk corridors programs."

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IRS Announces 2027 HSA, HDHP, HRA, DPCSA Limits

"The [IRS] recently announced cost-of-living adjustments to the applicable dollar limits for health savings accounts (HSAs), high-deductible health plans (HDHPs), and excepted benefit health reimbursement arrangements (HRAs) for 2027. In addition, this year's guidance includes inflation-adjusted limits for the aggregate fees that can be made available under direct primary care service arrangements (DPCSAs), which were first made available under the One Big Beautiful Bill Act (OBBBA). Most of the dollar limits currently in effect for 2026 will change for 2027."  MORE >>

OBBBA's Impact on Employee Benefit Plans, Programs, and Arrangements

"[P]lan sponsors should consider the following measures ... [1] Reevaluate dependent care FSAs.... [2] Consider retroactively or prospectively reinstating first-dollar telehealth and other remote-care service coverage under HDHPs.... [3] Identify whether to adopt or further explore [direct primary care] arrangements.... [4] Review current or potential employer-provided childcare programs in light of expanded tax credits.... [5] Evaluate and make any required updates to plan documents in light of the OBBBA and any changes adopted."  MORE >>

Vermont Enacts New Telehealth Legislation Impacting Insurers

"The legislation, which goes into effect on September 1, 2025, requires that health insurance plans provide coverage for healthcare and dental services delivered through telemedicine to the same extent as if the services were provided through in-person consultations."  MORE >>

New EO Targets Prescription Drug Costs

"[T]he provisions of [Executive Order 14273] appear intended to drive down the prices that the federal government pays for drugs and reduce out-of-pocket costs for patients, with many provisions designed to do both.... [P]rivate payors are also targeted through efforts to increase transparency in their compensation models."  MORE >>

IRS Announces 2026 Limits for HSAs, HDHPs, HRAs

"All of the dollar limits currently in effect for 2025 will change for 2026, with [one] exception ... The HSA catch-up contribution for individuals ages 55 and older will not change as it is not subject to cost-of-living adjustments.... [A table] compares the applicable dollar limits for HSAs, HDHPs, and excepted benefit HRAs for 2025 and 2026."  MORE >>

PBMs Score a Win in Federal Court Against State Regulation

"[T]he McKee court held that Tennessee's 'any willing pharmacy' law had an impermissible connection with ERISA plans and was therefore preempted. In so holding, the court rejected the state of Tennessee's reliance on Rutledge. Critically, Rutledge involved a form of cost regulation, not plan structure. By contrast, pharmacy networks -- at issue in McKee -- are plan structures." [McKee Foods Corporation v. BFP Inc., No. 21-0279 (E.D. Tenn. Mar. 31, 2025)]  MORE >>

Group Health Coverage Alternatives for Small Employers

20 pages; updated Apr. 2025. "For small employers, there are, broadly speaking, three commonly encountered alternative approaches that have gained traction in the marketplace.... This Special Report examines and explains these options available to, and the obstacles routinely encountered by, small employers as they seek to make affordable health insurance coverage available to employees and their families."  MORE >>

Senate Judiciary Committee Advances Six Pharma Bills

"The package collectively targets several aspects of the pharmaceutical landscape, including pharmaceutical benefit manager (PBM) pricing practices, next-generation drug releases, patent portfolio assertions, and use of [FDA] regulatory mechanisms.... [It] is significant that the six bills were moved to the full Senate with bipartisan support."  MORE >>

Reproductive Health Under the Trump Administration So Far

"Over the past two months, the second Trump administration has shifted federal policies and priorities regarding abortion, in vitro fertilization (IVF), contraception, and other reproductive-health-related matters -- and it is expected to continue to do so. In addition to the federal policy agenda, many developments related to reproductive health likely will continue to occur at the state level.... This article discusses some of the major recent trends in women's health and reproductive health, and what is likely to come next under the new administration."  MORE >>

Breaking Down the New No Surprises Act FAQs Post-TMA III

"If the Trump administration decides to draft new QPA regulations, it could make additional changes to the QPA methodology beyond those that have been the subject of litigation. While the courts have provided direction on what is permissible under the NSA and what aspects of previous regulations can and cannot stand, the rulings do not prevent the Trump administration from making other permissible regulatory changes as it deems appropriate, especially as stakeholders have challenged implementation of the law under the previous administration."  MORE >>

Group Health Coverage Alternatives for Small Employers

19 pages. "For small employers, there are, broadly speaking, three commonly encountered alternative approaches that have gained traction in the marketplace.... This Special Report examines and explains these options available to, and the obstacles routinely encountered by, small employers as they seek to make affordable health insurance coverage available to employees and their families."  MORE >>

Trump Places DOL's ESOP Proposals in Regulatory Moratorium

"Ultimately, the new administration must now work its way through the proposed, and now suspended, regulations and PTE issued by the prior administration to determine what, if anything, will be kept on reissuance (if any). Practitioners, in the meantime, are left with the prior, antiquated guidance and significant uncertainty."  MORE >>

Congress Extends Some Telehealth Flexibilities Through March 31

"The extension indicates bipartisan support for continuing coverage for telehealth services, but the short timeline warrants continued stakeholder engagement for the extension and eventual permanence of the Medicare telehealth flexibilities and reinstatement of the HDHP safe harbor. As the new administration takes office, it is unclear where telehealth will fall on the list of priorities."  MORE >>

New Trans-Inclusive Healthcare Requirements for California Health Plans

"Beginning in the first quarter of 2025, California healthcare service plans, health insurers, Medi-Cal managed care plans, and PACE organizations must ensure that staff who have direct enrollee contact receive evidence-based cultural competency training focused on transgender-inclusive healthcare.... Provider directories must also be updated by March 1, 2025, to identify which in-network providers have previously offered gender-affirming services."  MORE >>

New Rules Simplify ACA Employer Shared Responsibility Reporting Obligations

"Action items for ALEs ... [1] Ensure your benefits team is familiar with the new rules and understands the specific changes and how they impact your reporting obligations.... [2] For plan sponsors that want to take advantage of the reporting relief, prepare and make available the required notice by January 31, 2025. Ensure the notice is clear, conspicuous, and accessible, providing all necessary contact information for employees to request a copy of their form.... [3] Keep an eye out for an IRS Letter 226-J or related follow-up notices from the IRS and ensure you respond within the required 90 days or request an extension."  MORE >>

HHS OCR Proposes Significant Modifications to HIPAA Security Rule

18 pages. "If finalized, these would be the first modifications of the Security Rule since 2013 and could entail significant additional compliance obligations and costs for HIPAA covered entities and business associates.... [A] redline of the existing language of the Security Rule with the NPRM's proposed modifications is available ... HHS states that the NPRM is intended to address ... significant increases in breaches and cyberattacks; common deficiencies OCR has observed in investigations into Security Rule compliance; ... and court decisions that affect the enforcement of the Security Rule."  MORE >>

Complying with the MHPAEA's 'Relevant Data' Requirement

"The relevant data evaluation requirement has proven especially challenging for self-funded group health plans of every size, as third-party administrators fail, refuse, or are otherwise unable to provide the information necessary to comply.... Some large carriers have shared the NQTL analysis that they previously prepared for their fully insured groups with the self-funded group to whom they provide administrative services. Presumably, this will give their self-funded groups a starting point."  MORE >>

Important Benefit Plan Considerations for Year-End and 2025

"Retirement Plans: Plan sponsors should engage in conversations with their recordkeeper about implementation of the many optional provisions under SECURE 2.0.... Though SECURE 2.0 plan amendments are not due until December 31, 2026, plan sponsors should update the plan's summary plan description to include any SECURE 2.0 changes already in effect.... Health and Welfare Plans: [HIPAA] reproductive healthcare rights ... Section 408(B)(2)(b) fee disclosures ... Mental health parity ... Cybersecurity."  MORE >>

IRS Offers Insight Into Matching Qualified Student Loan Payments

"A plan with a QSLP matching contribution can choose to test all employees together or separately test employees who receive a QSLP matching contribution for actual deferral percentage (ADP) testing purposes. With respect to safe harbor plans, a QSLP matching contribution may be added as a mid-year change."  MORE >>