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All News > Health Plan Policy

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Mercer Comment Letter Responding to House Committee RFI on Ways to Strengthen ERISA (PDF)
Mercer Link to more items from this source
[Opinion]
Mar. 25, 2024

"Mercer recommends the committee direct the Congressional Research Service to publish an extensive report on ERISA preemption. Copies of the report should be sent to every state's insurance commissioners and legislators, as well as the leadership of the National Association of Insurance Commissioners  ... Mercer recommends building on recent transparency improvements to ensure that group health plan fiduciaries have access to the information they need to better fulfill existing fiduciary duties, including selecting and monitoring service providers that administer plan benefits."

Tags: ERISA Preemption  •  Fiduciary Duties  •  Health Plan Administration  •  Health Plan Policy

NABIP Response to House Committee RFI on Ways to Strengthen ERISA (PDF)
NABIP [National Association of Benefits and Insurance Professionals] Link to more items from this source
[Opinion]
Mar. 22, 2024

30 pages. "The Committee may want to act relatively quickly to shore up the strength of ERISA's preemptive standard before any potential SCOTUS action on Mulready.... [NABIP] strongly suggest[s] that Congress adjust the definitions of fiduciary and service provider within ERISA to create specific definitions for health and welfare plans.... Congress should ensure that the entity holding the information or the entity responsible for its determination should be the one responsible for any federal reporting or data compilation requirement.... It is unfair and unreasonable to hold the employer responsible and liable for reporting information they cannot control."

Tags: Health Plan Policy

Payers, Providers Share Diverging Asks for ERISA Updates
FierceHealthcare Link to more items from this source
Mar. 20, 2024

"ERISA is turning 50 this year and lawmakers are curious to hear about how the law could be updated to increase coverage affordability and care access. Payers and providers, it turns out, have very different ideas on where Congress should focus its efforts."

Tags: Health Plan Policy

Congress Considers PBM Reform
Faegre Drinker, via Innovations Magazine Link to more items from this source
Mar. 19, 2024

"Core themes of these pieces of legislation are increasing transparency of PBM operations and prohibitions or limitations on the use of spread pricing, a technique where PBMs could profit from the margin between what health plans are charged and what is paid to pharmacies, potentially incentivizing formularies to favor more costly drugs.... A deep dive into these significant bills will help us understand the potential landscape of PBM regulation and its far-reaching implications for the health care system."

Tags: Health Plan Policy  •  Prescription Drug Costs

2025 Federal Budget Proposal Nearly Identical to Prior Years on Health, Retirement
Groom Law Group Link to more items from this source
Mar. 19, 2024

"Many of the FY 2025 budget proposals track those made in prior Biden Administration budgets.... [This article outlines] key health, retirement, and benefits-related provisions in the budget."

Tags: Health Plan Policy  •  Retirement Plan Policy

Congress Has the Opportunity to Deliver Health Care Price Transparency
Health Affairs Forefront Link to more items from this source
[Opinion]
Mar. 18, 2024

"[With] positive momentum from policy makers in both chambers of Congress and on both sides of the aisle, the likelihood of a final price transparency bill getting passed and signed into law seems high. [Two current] proposals include many of the same provisions but differ in other ways. So, what would these price transparency provisions do? Which provisions could have the most significant impact on the cost of health care for consumers and employers? And what more still needs to be done to fully achieve the cost-containment objectives of requiring price transparency in health care?"

Tags: Health Plan Costs  •  Health Plan Policy

CAHC Response to House Committee on Education and the Workforce RFI on Strengthening ERISA (PDF)
Council for Affordable Health Coverage [CAHC] Link to more items from this source
[Opinion]
Mar. 18, 2024

"CAHC believes Congress should instead strengthen ERISA by [1] expanding options for employers and their employees; [2] providing financial incentives to ensure employer coverage remains viable; and [3] enacting policies to lower the cost of health services and drugs to reduce premiums and out-of-pocket costs."

Tags: Health Plan Policy

PACT Letter to Congress: Recommendations to Improve and Modernize Mental Health Care (PDF)
Protecting Americans’ Coverage Together (PACT), Link to more items from this source
[Opinion]
Mar. 18, 2024

"While employers have made significant progress responding to the mental health challenges faced by their workforce, Congress and the Administration should take meaningful steps to break down obstacles that are critical to enhancing mental health services across the nation. Through expanding access to telehealth, strengthening the provider workforce, and better integrating care, ... barriers to quality care will be reduced, patient outcomes will be better, and costs will be lowered."

Tags: Health Plan Design  •  Health Plan Policy  •  Teleheath

Will the Change Healthcare Incident Change Health Care?
Health Affairs Forefront Link to more items from this source
[Opinion]
Mar. 15, 2024

"The Change cyberattack has precipitated financial crises for care providers large and small and for patients, as well as for Change's immense owner, the $371 billion UnitedHealth Group. It has graphically demonstrated the vulnerability of a bewilderingly complex proprietary medical payment system. It is a 'Deepwater Horizon' moment in American health care finance."

Tags: Health Plan Administration  •  Health Plan Policy

American Benefits Council Response to House Committee on Education and the Workforce RFI on Ways to Strengthen ERISA
American Benefits Council Link to more items from this source
[Opinion]
Mar. 15, 2024

"Preemption is fundamental to ERISA working as intended.... [T]he Council recommends to the committee that additional detail be added to ERISA's prohibited transaction rules as they pertain to health plans ... to require plan service providers ... to disclose to the plan and the plan fiduciary in advance of services being provided both the affiliate status of the party/provider and ... the cost that will be charged with respect to any services being provided by the affiliate."

Tags: ERISA Preemption  •  Health Plan Policy

ERIC Response to House Committee on Education and the Workforce RFI on Ways to Strengthen ERISA (PDF)
The ERISA Industry Committee [ERIC] Link to more items from this source
[Opinion]
Mar. 15, 2024

"ERIC continues to support congressional efforts to designate that vendors involved in critical plan design and administration decisions, including an entity providing pharmacy benefit management services, are fiduciaries within the meaning of section 3(21) of ERISA with respect to a group health plan or group health insurance coverage.... Transparency is needed regarding PBM compensation sources.... There are multiple frameworks and standards that health plan sponsors and ERISA fiduciaries already comply with and use to protect sensitive plan and participant data.... The introduction of new or broadened requirements under ERISA would be redundant and would contribute to further complexity and administrative costs."

Tags: ERISA Preemption  •  Health Plan Policy

President's FY 2025 Budget Seeks to Expand Mental Health Coverage and Protections
Miller & Chevalier Link to more items from this source
Mar. 14, 2024

"The Biden administration released its fiscal year (FY) 2025 budget on March 11, 2024, and it contains multiple legislative proposals that, if enacted into law, would significantly impact mental health and substance use disorder coverage offered through ERISA health plans. Although a president's budget proposal is akin to a wish list, especially during an election year, the FY 2025 proposal reveals aspirational mental health initiatives that the current administration would like to see become law."

Tags: Health Plan Design  •  Health Plan Policy

CRS Insight: The Change Healthcare Cyberattack and Response Considerations for Policymakers (PDF)
Congressional Research Service [CRS] Link to more items from this source
Mar. 13, 2024

"Arguably, the incident itself is not remarkable as ransomware attacks are common. The entity that was targeted, and its effect on the broader ecosystem, however, is notable. This incident highlights the healthcare system's interconnected nature and nationwide reach, and the broader impact of the disruption on economic activity." [IN12330 updated Mar. 14, 2024]

Tags: Health Plan Policy

Fifth Circuit Poised to Uphold Ruling Striking Down Preventive Coverage Requirement
Health Law Advisor, Epstein Becker Green Link to more items from this source
Mar. 8, 2024

"While the entire ACA preventive coverage framework is before the court, the oral arguments focused entirely on two issues: the constitutionality of the appointments of members of the Task Force and the appropriate remedy should the court side with the plaintiffs.... The government also advanced arguments suggesting that Secretary Becerra's retroactive ratification of all Task Force recommendations and subsequent reappointment of its members resolved any remaining constitutional defects. The court seemed skeptical on the latter point." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022; on appeal to 5th Cir. No. 23-10326)]

Tags: Health Plan Design  •  Health Plan Policy

Text of IRS Notice 2024-28: Public Recommendations Invited on Items to Be Included on the 2024-2025 Priority Guidance Plan (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Mar. 8, 2024

"The Department of the Treasury and the [IRS] invite the public to submit recommendations for items to be included on the 2024-2025 Priority Guidance Plan.... The 2024-2025 Priority Guidance Plan will identify guidance projects that the Treasury Department and the IRS intend to actively work on as priorities during the period from July 1, 2024, through June 30, 2025."

Tags: Health Plan Administration  •  Health Plan Policy  •  Retirement Plan Administration  •  Retirement Plan Policy

Agencies Request Public Input as Part of Inquiry Into Impacts of Corporate Ownership Trend in Health Care
Antitrust Division, U.S. Department of Justice [DOJ]; Federal Trade Commission [FTC]; and U.S. Department of Health and Human Services [HHS] Link to more items from this source
Mar. 7, 2024

"The cross-government inquiry seeks to understand how certain health care market transactions may increase consolidation and generate profits for firms while threatening patients' health, workers' safety, quality of care and affordable health care for patients and taxpayers. The agencies issued a Request for Information (RFI) requesting public comment on deals conducted by health systems, private payers, private equity funds and other alternative asset managers that involve health care providers, facilities or ancillary products or services. The RFI also requests information on transactions that would not be reported to the Justice Department or FTC for antitrust review under the Hart-Scott-Rodino Antitrust Improvements Act."

Tags: Health Plan Policy

White House Holds Roundtable on Lowering Healthcare Costs and Bringing Transparency to Prescription Drug Middlemen
Executive Office of the President Link to more items from this source
Mar. 6, 2024

"[On March 5,] senior officials from across the Administration ... convened a listening session with leaders from across state government, the private sector, and community pharmacies to discuss President Biden's work to lower health care costs and hear ideas for bringing transparency to prescription drug middlemen.... Participants discussed a range of approaches that have been used to bring down costs across states and private employers.... Participants also discussed flaws in the current marketplace.... Several participants also highlighted how middlemen can affect independent pharmacies." [Also available: video of roundtable discussion]

Tags: Health Plan Costs  •  Health Plan Policy

White House Turns to Health Care in Latest Move Against 'Corporate Greed'
Politico Link to more items from this source
Mar. 6, 2024

"The White House plans to announce a new federal task force focused on easing health care costs ... Officials from the Justice Department, the Federal Trade Commission and the Department of Health and Human Services will be on the task force, focused on enforcement ... [D]rug pricing and health provider costs will be among the task force's central focus."

Tags: Health Plan Costs  •  Health Plan Policy

District Court Rules Administration Can't Make Religious Employers, Healthcare Firms Cover Gender Treatments
Just the News Link to more items from this source
Mar. 5, 2024

"The court found that CEA's refusal to comply with EEOC and HHS mandates on the grounds of their faith would result in significant monetary penalties and therefore, the mandates 'substantially burdened' the organization." [Christian Employers Alliance (CEA) v. EEOC, No. 21-0195 (D. N. Dak. Mar. 4, 2024)]

Tags: Health Plan Design  •  Health Plan Policy

Will Religious Freedom Claims Trump Public Health? Braidwood and HIV Prevention
Health Affairs Forefront Link to more items from this source
[Opinion]
Mar. 4, 2024

"By declining to argue the RFRA claims before the Fifth Circuit, the government may have saved the question for another day and avoided setting a national legal precedent. However, even applying the obligatory strict scrutiny standard, mandatory PrEP coverage should withstand the plaintiffs' RFRA claims for several reasons." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022; on appeal to 5th Cir. No. 23-10326)]

Tags: Health Plan Design  •  Health Plan Policy

Oregon's Drug Price Transparency Law Deemed Unconstitutional by Federal District Court
Sidley Austin LLP Link to more items from this source
Feb. 29, 2024

"[T]he court held that [1] HB 4005's price increase reporting requirements violate the First Amendment and [2] HB 4005 effects an unconstitutional taking of drug manufacturers' private property by authorizing the state to manufacturers' trade secrets if the 'public interest' requires such publication. The ruling ... could spur challenges to similar drug price transparency laws in other states." [Pharmaceutical Research and Manufacturers of America v. Stolfi, No. 19-1996 (D. Ore. Feb. 16, 2024)]

Tags: Health Plan Policy  •  Prescription Drug Costs

Justice Department Opens UnitedHealth Antitrust Probe
The Wall Street Journal; subscription may be required Link to more items from this source
Feb. 28, 2024

"The Justice Department has launched an antitrust investigation into UnitedHealth, owner of the biggest U.S. health insurer, a leading manager of drug benefits and a sprawling network of doctor groups.... [I]nvestigators have asked about issues including certain relationships between the company's UnitedHealthcare insurance unit and its Optum health-services arm, which owns physician groups, among other assets."

Tags: Health Plan Policy

Senate Panel Advances Su Nomination as Labor Secretary
ThinkAdvisor Link to more items from this source
Feb. 28, 2024

"The Senate Health Education, Labor and Pensions Committee voted 11-10 on [February 27] to advance Julie Su's nomination as Labor Secretary ... Su's nomination will now await a floor vote ... Su's previous nomination failed to secure a Senate vote before her nomination was returned to the White House at the conclusion of the first session of the 118th Congress,"

Tags: Health Plan Policy  •  Retirement Plan Policy

Modernizing Mental Health Care in America
Protecting Americas Coverage Together [PACT] Link to more items from this source
[Opinion]
Feb. 27, 2024

"While employers have made significant investments to address the ongoing health challenge compounded by workforce shortages, more action is needed by policymakers to provide the support that millions of people need right now. By further expanding access with telehealth, strengthening the provider workforce, and better integrating care, we can improve mental health."

Tags: Health Plan Design  •  Health Plan Policy

Editor's Pick ERISA Litigation and Regulation: 2023 in Review and Future Outlook
DeBofsky Law Link to more items from this source
Feb. 23, 2024

"ERISA will reach a major milestone in 2024 -- its fiftieth anniversary since its enactment on Labor Day of 1974. However, there is much about how the law works that remains unsettled.... 2023 produced new ERISA regulatory initiatives and groundbreaking judicial rulings.... [S]ome of the major highlights are discussed [in this article], along with a prediction about what 2024 may bring."

Tags: Health Plan Administration  •  Health Plan Policy  •  Retirement Plan Administration  •  Retirement Plan Policy

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