[Guidance Overview]

Agencies Propose Rules to Implement No Surprises Act Federal Independent Dispute Resolution Process

"[The qualifying payment amount (QPA)] will generally be a payor's median in-network rate for: (a) the same or similar services, (b) furnished in the same or a similar facility, (c) by a provider of the same or similar specialty, (d) in the same or similar geographic area.... [T]he QPA is now the presumptive out-of-network rate that an IDR entity must select absent credible evidence that the payor's QPA would be inappropriate under the circumstances."  MORE >>

K&L Gates

[Guidance Overview]

Pittsburgh Extends Mandatory COVID-19 Paid Sick Leave

"The new ordinance primarily acts as a temporal extension of the December 2020 ordinance, and it does not impose additional sick time requirements beyond the formula set forth in that ordinance."  MORE >>

Society for Human Resource Management [SHRM]; membership may be required to view article

An Analysis of the Generosity of Employment-Based Health Insurance, 2013–2019

"Both average and median [actuarial value (AV)] were about 83 percent in each year from 2013 to 2019.... The average AV for enrollees in health maintenance organizations (HMOs)/exclusive provider organizations (EPOs) was highest.... [P]lans linked to spending accounts had the lowest AVs. Average AV increased for every type of health plan between 2013 and 2019."  MORE >>

Employee Benefit Research Institute [EBRI]

Latest 'Build Back Better' Framework: Extended ACA Enhancements, No Medicare Rx Drug Negotiation Authority

"After much negotiation, on October 28, 2021, the White House issued a highly anticipated framework and then the House Rules Committee released revised legislative text ... [and a] section-by-section summary of the bill ... It is not yet clear when the House will take up the Build Back Better Act, and it is possible that some negotiations may continue. This post summarizes the coverage-related provisions with an emphasis on the [ACA] and the Medicaid coverage gap."  MORE >>

Katie Keith, in Health Affairs Blog

Third Circuit Upholds Termination After Failure to Provide FMLA Recertification

"To make a claim of interference under the FMLA, the plaintiff must establish, among other factors, that they were denied benefits to which they were entitled to -- entitlement requires a showing that the employee submitted certification or recertification forms for their requested leave. Without such recertification, the employee is ineligible for FMLA leave and therefore, not entitled to any FMLA benefits." [Watson v. Drexel Univ., No. 20-3001 (3d Cir. Sep. 27, 2021; unpub.)]  MORE >>

Archer

IRS Updates Process for Issuing FAQ Guidance and Clarifies Scope of Reliance

"Although FAQs provide crucial and timely guidance that can help taxpayers understand new tax laws, ... they are neither precedential nor binding on the IRS, and they may be deleted or modified at any time without any official record of prior versions. This announcement of a more formal process for issuing and tracking FAQ guidance, combined with the clarifying statement on reliance, is a positive development. Also helpful is the IRS's promise to retain past versions of FAQ guidance, but cautious taxpayers and their advisors should still save their own copies."  MORE >>

Thomson Reuters / EBIA

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Fundamentals of Employee Well-Being

November 2, 2021 WEBCAST

Validation Institute

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'No Surprises Act' Disclosure Notice

Vorys

Mental Health Parity: Health Plans Must Comply with New Documentation Requirements

Morris, Manning & Martin, LLP

Does Your Plan Use a Limited Scope Audit for Form 5500 Financial Reporting?

The Wagner Law Group