Search the News Archive

National Association of Insurance Commissioners to Review Pharmacy Benefit Management in 2016

"[T]he National Association of Insurance Commissioners (NAIC) ... 2016 work plan for its Health Insurance and Managed Care (B) Committee ... [includes] among other things, 'review and, if necessary, consider revisions to the Health Carrier Prescription Drug Benefit Management Model Act (#22) -- adopted in 2003 -- to address issues related to: [1] transparency, accuracy and disclosure regarding prescription drug formularies and formulary changes during a policy year; [2] accessibility of prescription drug benefits using a variety of pharmacy options; and [3] tiered prescription drug formularies and discriminatory benefit design.' ... [C]ommittee members indicated support for soliciting initial public comments from interested stakeholders in January, and to begin periodic conference calls in February to consider changes to the model."  MORE >>

Text of SEC National Exam Program Risk Alert: Retirement-Targeted Industry Reviews and Examinations Initiative (PDF)

"[SEC's Office of Compliance Inspections and Examinations (OCIE)] is launching a multi-year Retirement-Targeted Industry Reviews and Examinations (ReTIRE) Initiative.... OCIE, through the National Examination Program (NEP), will conduct examinations of SEC-registered investment advisers and broker-dealers (collectively, registrants) under the ReTIRE Initiative that will focus on certain higher-risk areas of registrants' sales, investment, and oversight processes, with particular emphasis on select areas where retail investors saving for retirement may be harmed.... NEP staff intends to focus on certain registered investment advisers and broker-dealers that provide services or sell investment products to retail investors. Examination focus areas include: reasonable basis for recommendations; conflicts of interest; supervision and compliance controls; and marketing and disclosure."  MORE >>

New York Senate Passes First-In-The-Nation Bill Requiring Mandatory Review and Revocation Period for All Severance Agreements

"[The No Severance Ultimatums Act (S 372) would require] employers to provide employees with at least 21 business days to review a separation agreement, and seven calendar days to revoke the separation agreement (meaning an agreement cannot become effective or enforceable until the revocation period has expired). While employees can voluntarily sign a separation agreement before the required consideration period expires, the revocation period is not waivable."  MORE >>

Developing a Review Process for Implementing National Health Care Reform

"[GFOA] recommends that state and local government employers that sponsor group health plans implement a process for reviewing federal health-care benefit requirements at least annually. Doing so will allow employers to plan ahead, allowing them to use the most cost-effective approach to ensuring compliance while offering appropriate benefit levels and options to employees and retirees."  MORE >>

National Association of Insurance Commissioners Comment Letter to HHS on Proposed Health Insurance Market Rules and Rate Reviews (PDF)

"While subsidies and higher cost-sharing options may be of some assistance, in most states, these populations could have their individual market rates rise considerably in 2014. This potential "rate shock" could, in turn, result in their leaving the marketplace, even with the penalties, which are quite low in the first years. States need as much flexibility as possible under the law to work with issuers to address this problem."

MORE >>

Book Review: One Nation, Uninsured -- Why the U.S. Has No National Health Insurance

Excerpt: Tens of millions of Americans cannot afford basic care. It's a serious problem -- but not, Jill Quadagno reminds us in One Nation, Uninsured , a particularly novel one. On the contrary, similar health care 'crises' cropped up repeatedly during the 20th century, always playing out in the same unfulfilling way. First, anxiety over affordable health care leads progressive politicians to push for universal health insurance. Then the campaign fails.

MORE >>

For Nation, a Mixed Review on Health -- Study of 50 States Finds

Excerpt: Scrape off the color on the red states and the blue states and underneath is a different way of looking at America's regional differences. There are the smoking states and the obesity states; the high-infant-mortality states and the stay-in-high-school states; the heart attack states and the killed-on-the-job states. Today, for the 15th time, a public health organization is releasing its assessment of the health of the nation, ..., as measured by a composite of 18 variables.

MORE >>

National Review of HIPAA Compliance Finds Rampant Confusion and Mistakes

Excerpt: Four years after the privacy rule went into effect, hospitals and other covered entities (CEs) are struggling with basic concepts that underlie compliance, such as what the 'minimum necessary' standard means. Mistrust among CEs is rampant, and many have implemented business practices in the name of privacy and security that have no basis in law.

MORE >>

National Review of HIPAA Compliance Finds Rampant Confusion and Mistakes

Excerpt: In addition to misapplying minimum necessary to treatment, the study also documents pervasive confusion about how state laws dovetail with HIPAA, particularly in the area of substance abuse and mental health treatments, and overlapping and conflicting practices concerning patient consent policies and procedures.

MORE >>

Text of Amicus Brief by ERISA Industry Committee Seeking Full Ninth Circuit Review of San Francisco Employer 'Play-or-Pay' Ordinance (PDF)

22 pages. Excerpt: This past Friday, October 31, 2008, The ERISA Industry Committee (ERIC) and the National Business Group on Health (NBGH) -- two organizations representing large, national employers providing health benefits to tens of millions of Americans -- filed an amicus brief supporting the Golden Gate Restaurant Association's call for a full Ninth Circuit Court of Appeals review of the city of San Francisco's controversial play or pay ordinance on employers.  MORE >>

Amicus Brief of American Benefits Council to Tenth Circuit on Ruling That Deferential Standard of Review Requires Disclosure of Plan Administrator's Discretionary Authority (PDF)

12 pages. "In a nationally unprecedented ruling, the panel majority held that, under ERISA, a deferential standard of review on judicial review of a benefits claim applies only where a plan administrator has disclosed 'its reservation of discretionary authority.'... The majority's requirement is counter to ERISA itself, the precedents addressing ERISA's standard of review, and [DOL] regulations. Furthermore, the majority's rule undermines the important interests that the standard of review protects: 'efficiency, predictability, and uniformity.' " [Lyn M. v. Premera Blue Cross, No. 18-4098 (10th Cir. Jul. 24, 2020)]  MORE >>

Text of DOL Technical Release No. 2013-01: Extension of the Transition Period for the Temporary NAIC-similar State External Review Process under the ACA

"On June 22, 2011, the Departments issued Technical Release 2011-02 ... which established a transition period until January 1, 2012 for State external review process implementation and a set of temporary standards similar to the consumer protections set forth in the Uniform Health Carrier External Review Model Act issued by the National Association of Insurance Carriers (the 'NAIC-similar process') that would apply until January 1, 2014 for a State-administered external review process ... This technical release updates and clarifies T.R. 2011-02 and extends the applicability of the temporary NAIC-similar process standards until January 1, 2016. During this extended transition period, States that CCIIO has already determined to meet the NAIC-similar process standards will continue to be considered compliant ... until January 1, 2016."

MORE >>

Supreme Court Will Review Setting of Withdrawal Liability Assumptions

"The court's review will be limited to one question: Must the plan use the actuarial assumptions most recently adopted before the 'measurement date' for determining withdrawal liability, or can the plan use assumptions adopted after the measurement date based on information that was available as of that date? The decision may have a significant effect on the calculation of withdrawal liability for all multiemployer plans across the country." [M & K Employee Solutions, LLC v. Trustees of the IAM National Pension Fund, No. 22-7157 (D.C. Cir Feb. 9, 2024; cert. pet. granted Jun. 30, 2025 No. 23-1209)]  MORE >>

DOL Provides Major Group Health Plan Timeframe Extensions for COVID-19 National Emergency

"The new final rule extends [certain] timeframes to assist employers and employees in the process of maintaining employer-sponsored group health plan coverage.... [1] The HIPAA special enrollment period ... [2] The COBRA election period ... [3] The COBRA premium payment period ... [4] COBRA Notices from employees re divorce/legal separation, child reaching age 26, and disability ... [5] The plan's benefit claim filing deadline ... [6] The ERISA adverse benefit determination appeal deadline ... [7] The ERISA external review request deadline ... [8] The deadline to submit additional information related to external review request."  MORE >>

Supreme Court to Hear Pension Withdrawal Liability Case That May Impact Most of the Nation's Multiemployer Plans

"[W]ithdrawn employers complained that setting assumptions after the valuation date allowed the trustees to 'retroactively' increase their withdrawal liability. The arbitrators agreed with the employers, but the district court reversed ... With the PBGC's support, the [Solicitor General] advised that that case warranted immediate review because even relatively small changes in assumptions can affect withdrawal liability bills by millions of dollars and 'the dueling rules' can 'open any determination of withdrawal liability to challenge.' " [M & K Employee Solutions, LLC v. Trustees of the IAM National Pension Fund, No. 22-7157 (D.C. Cir Feb. 9, 2024; cert. pet. granted Jun. 30, 2025 No. 23-1209)]   MORE >>

A Look at GASB’s Post-Implementation Review of Pension Standards

"Earlier this year, the Governmental Accounting Standards Board (GASB) completed an extensive post-implementation review (PIR) of the pension standards issued in 2012, Statement No. 67, Financial Reporting for Pension Plans, and Statement No. 68, Accounting and Financial Reporting for Pensions. NCPERS spoke with the GASB team about the review and the report issued at its conclusion earlier this year."  MORE >>

Eleventh Circuit: De Novo Review of ERISA Benefit Decision Cannot Be Limited to the Administrative Record

"Though everyone agreed that de novo review applied to the court's review of Lincoln's decision, the district court excluded Harris' post-denial evidence ... The Eleventh Circuit found this evidentiary ruling constituted error under Eleventh Circuit precedent." [Harris v. The Lincoln National Life Ins. Co., No. 21-13186 (11th Cir. Jul. 29, 2022),]  MORE >>

SEC Greenlights Climate Review of 401(k) Options

"As You Sow, a group that describes itself as the nation's non-profit leader in shareholder advocacy, recently received backing from the SEC in its bid to include a proposal for shareholder vote that, if approved, would require Amazon ... to 'at reasonable expense and excluding proprietary information, prepare a report reviewing the Company's retirement plan options with the board's assessment of how the Company's current retirement plan options align with its climate action goals.' "  MORE >>

35-State Pediatric Group Claims Aetna Doesn't Review Medical Charts in Lawsuit Alleging Insurer Values Profits Over Care

"A national physician group is suing Aetna for 'improperly interfering with medical care,' alleging the insurer tried to claw back payments for necessary patient care, furthering accusations that the company fails to review patient charts.... The physician group, with employs 1,750 specialists across 35 states, also raised concerns that the insurer does not review medical charts when evaluating claims payments[.]"

MORE >>

Review of CMS Proposed 2018 Risk Adjustment Changes to CSR Plans (PDF)

"Wakely reviewed CMS' proposed 2018 risk adjustment changes to cost-sharing reduction (CSR) plans and modeled the impact of the changes based on collected 2016 data. [The] modeling with national data shows that relative risk will decrease around 10% for the 87% and 94% CSR plans while all other plans' relative risk will increase at varying levels to offset the changes to CSR plans."  MORE >>