"Some argue that telehealth requires less clinical effort and fewer overhead costs than in-person care, undercutting the case for payment parity.... Those who support payment parity believe it would help clinicians adopt and maintain telehealth as a way to support health care access and patient experience. Arguments on both sides would be strengthened by more high-quality studies."

17 pages; Jul. 30, 2021. "CMS issued this toolkit to help health insurance issuers and Medicare Advantage plans identify the issues that need to be considered and addressed in order to provide coverage and reimbursement for vaccine administration. Because COVID-19 vaccines will be federally purchased, this toolkit primarily focuses on vaccine administration.... This toolkit:

• Provides a list of operational considerations for issuers and Medicare Advantage plans as they design their approach to promoting COVID-19 vaccinations, and information on how issuers and Medicare Advantage plans can communicate with providers and enrollees on vaccinations and coverage;
• Outlines legislative and regulatory provisions applicable to issuers that ensure that enrollees can receive a COVID-19 vaccine in a convenient setting, with no out-of-pocket costs;
• Encourages issuers and Medicare Advantage plans to implement streamlined processes to quickly administer COVID-19 vaccine coverage; and
• Describes how issuers and Medicare Advantage plans can maximize the number of their enrollees who get vaccinated once a COVID-19 vaccine becomes available."

"Although the guidance acknowledges that long COVID is not always a disability, it indicates that an individualized assessment is necessary to determine whether a person's condition or symptoms substantially limit a major life activity. The guidance also provides examples of when long COVID could meet that definition under applicable law."

"Several insurers and advocacy groups commented on the proposals outlined in the Centers for Medicare & Medicaid Services' Notice of Benefit and Payment Parameters, which outlines ACA marketplace exchange regulations for the 2022 coverage year. Insurers worried that extending the open enrollment period could lead to adverse selection and raise premiums for consumers."

"Health plans with policy years beginning on or after June 30, 2020, must cover PrEP as preventive care under the ACA.... The Final Recommendation gives information about whom the USPSTF determined to be at high risk for HIV acquisition.... The Departments' FAQs explain that plans must provide coverage without cost-sharing for PrEP drugs and items and services included as part of determining whether PrEP is appropriate for the individual and ongoing follow-up and monitoring."

"The process applies various 'what-if' scenarios to business contingencies so company leaders can make decisions based on the most likely scenario while staying flexible and able to adjust to changing conditions. It's an approach that HR can use to explore how different total rewards packages could maximize value for employees and minimize employer costs."

25 pages. "[S]olutions for Congress to consider [include]: [1] Allow mental health providers to practice across state lines to improve access to care ... [2] Expand telehealth benefits for all employees to improve access to providers ... [3] Ensure patients and plan sponsors have access to meaningful provider quality and safety information ... [4] Modernize health care account rules to increase flexibility for employees and improve access to mental and behavioral health ... [5] Reduce regulatory barriers to encourage employer innovation ... [6] Encourage the transition to value-based payments to better manage the costs of mental and behavioral health."

"The new federal guidance confirms that cost sharing protections extend to the ancillary and support services that are needed for an effective PrEP regimen. This means that all non-grandfathered private health plans must cover those services, alongside PrEP medication, without cost sharing. This clarification will reduce patient out-of-pocket costs and thus increase access to PrEP for high-risk individuals."

"This study found robust evidence that minimum wage increases lead to reductions in employer-sponsored insurance (ESI) coverage in families below 300% of the federal poverty level, with a nominal $1 increase in the minimum wage reducing the probability of ESI coverage by 1 percentage point. Reductions in coverage were also observed both for workers and for their dependents."

"Incentives may take many forms, such as a one-time bonus, a gift card or a few extra vacation hours. Employers can get creative. There are two issues to consider when implementing a vaccine incentive program for purposes of complying with employment and benefits laws: the concepts of coercion and reasonable accommodation."

"[T]he guidance states that 'the so-called long COVID does not automatically qualify as a disability' and specifies that, as is the case with other disability determinations, an 'individualized assessment is necessary' to determine if the person's condition or any of its symptoms is a physical or mental impairment that substantially limits one or more major life activities."

"[The Empowering Parents' Healthcare Choices Act (HR 4636)] would do away with 'the birthday rule' and a 'coordination of benefits policy' that trips up first-time parents up when it's time to sign up a new baby for insurance.... For Charlie Kjelshus, the birthday rule meant her dad's plan -- with a $12,000 deductible, a high coinsurance obligation and a network focused in a different state -- was deemed her primary coverage. Her mom's more generous plan was secondary. Confusion over the two plans caused a tangle of red tape for the family that took almost two years and national media attention to resolve."

"Eighty-five percent of voters like their current health care coverage.... 79 percent gave an excellent or good rating for high quality care; and 77 percent gave an excellent or good rating for choice in doctors.... 65 percent gave a negative rating for costs that are affordable; and 62 percent provided a negative rating for transparency in pricing.... Employer-provided health care coverage ... came out on top across all measures polled, particularly on choice, quality, and comprehensive coverage."

"The significant retention of employer-sponsored coverage during the pandemic further proves its value to individuals and families; as employment dropped over the course of the past year (at one point to 20%), the number of people with employer-sponsored insurance only incrementally fell by only 1% or 2%. It is particularly ironic that after such affirming statistics, some still support shifting individuals into Medicare or a public option."

"HB 3308 (Public Act 102-0104) will require individual and group accident or health insurance policies to cover clinically appropriate and medically necessary telehealth services, e-visits, and virtual check-ins in the same manner as any other covered benefits."

50 pages. "This report provides an overview of private health insurance billing and describes federal requirements related to surprise billing. Table A-1 summarizes all deadlines and deliverables required in the No Surprises Act. Appendix B summarizes additional provisions of the No Surprises Act not explicitly summarized or referenced elsewhere in the report. Table C-1 summarizes the applicability of federal surprise billing requirements to different surprise billing situations." [R46856, Jul. 26, 2021]

"It may come as a surprise to many employers that a worksite clinic offering more than limited first aid or providing benefits to 1099 workers or family members of employees is in most cases a group health plan subject to ERISA. This means that the worksite clinic is subject to plan documentation, fiduciary and reporting and disclosure requirements such as annual filing of a Form 5500 and distributing a summary plan description to employees describing the benefits offered at the clinic."

"Intended to provide patients protection against unanticipated medical expenses, the IFR will remove the predominant methodology used by health plans to pay out-of-network providers under the [ACA]. For out-of-network providers, the IFR creates administrative complexity and can result in reduced reimbursement."

"Most organizations use their employee benefits to help attract and retain top talent. For nonprofits, this is even more important -- while salaries at nonprofits will usually benchmark below average, their benefits will usually be in the top quartile.... This places more weight on the benefits offering and more importance on employee satisfaction with their benefits package."

"Major health systems, clinics and private practices alike pivoted swiftly to telemedicine when the covid-19 pandemic forced the nation to shelter in place and patients could no longer safely venture into health care settings. But the video services were not equally prepared for the titanic influx in users[.]"

"This paper discusses in more detail the questions that the Health Equity Work Group will explore regarding whether the methods of creating and valuing benefit designs contribute to health disparities among populations that are underserved or under-resourced, such as communities of color, or whether they might be helping to mitigate disparities. The questions outlined [in this paper] are applicable across markets, including the individual market, employer-sponsored coverage, Medicaid, and Medicare."

"Simply hiring one new employee costs more than $4,000.... [S]trong benefits packages can help companies avoid these issues. Eighty-nine percent of business owners with 50 or more employees say their benefits package boosts retention ... 58% of business owners in January 2021 said that employee benefits improve workforce productivity."

"[S]ome states have already taken action against these balance billing practices by implementing various forms of consumer protection laws over recent years.... For fully insured plans, the insurance carriers will need to update the plans they issue to incorporate the new regulations and maintain compliance with both state and federal laws."

"The IFR is largely focused on how the surprise billing protections apply to group health plans and health insurance issuers, as well as how the Qualified Payment Amount (QPA) is calculated. There are some rules related to the initial payment for surprise billing claims from providers and notices of denial, as well as provider-focused rules. The IFR generally hews closely to the CAA's provisions and provides some clarity regarding the calculation of the QPA amount."

"Employer-sponsored group health plans ... need to check with their group health plan's insurer or third-party administrator on how all elements of PrEP are being handled. Employers should also verify that the contents of their group health plan's summary plan description, plan document, and other employee communication materials accurately reflect the coverage of PrEP and are compliant with the requirements by September 17, 2021."