[Guidance Overview]

New York Paid Family Leave Law Expanded to Include Siblings

"The new coverage for siblings that will take effect in 2023 includes biological, adopted, step-, and half-siblings. Under the law, eligible employees receive 67 percent of their pay while on leave, up to a certain cap based on statewide average pay."  MORE >>

Constangy, Brooks, Smith & Prophete LLP

[Guidance Overview]

New York Confirms That Paid Leave for COVID-19 Vaccination May Be Used for Booster Shots

"[T]he NYSDOL revised its guidance to confirm that, even though the CDC has not yet incorporated booster shots into its definition of 'fully vaccinated' against COVID-19, paid COVID-19 vaccination leave nevertheless 'applies to any COVID-19 vaccination received by an employee, including booster shots.' New York employers should immediately update any COVID-related paid sick leave policies to reflect this change."  MORE >>

Reed Smith

Fifth Circuit Temporarily Blocks Biden Administration Vaccine Rules for Private Employers

"A three-judge panel on the New Orleans-based Fifth U.S. Circuit Court of Appeals granted an emergency stay prohibiting enforcement of the rules for now, saying they raise 'grave statutory and constitutional issues.' " [BST Holdings v. OSHA, No. 21-60845 (5th Cir. stay granted Nov. 6, 2021)]  MORE >>

The Wall Street Journal; subscription may be required

UnitedHealthcare and UBH Sued Over Denial of Certain Services Through Bundling Process

"The plaintiffs accuse UBH of having ... internal written policies that are deliberately designed to reduce the number and value of claims that UBH approves and pays to the detriment of the plan members and against their fiduciary obligation. According to the complaint, ... plan documents ... state the level of care for coverage be that services are consistent with generally accepted standards, but UBH's internal policies require a higher level of proof than the generally accepted standards." [Beach v. United Behavioral Health, No. 21-8612 (N.D. Cal. complaint filed Nov. 4, 2021)]  MORE >>

Law|Street

Supreme Court Will Hear Challenge to Dialysis Provisions of Medicare Secondary Payer Act

"The justices also will weigh in on a dispute filed by DaVita, the country's largest dialysis provider, over the interpretation of the Medicare Secondary Payer Act, which bars health plans from considering whether an individual is eligible for Medicare benefits because they suffer from kidney failure." [Marietta Memorial Hospital Employee Health Benefit Plan v. Davita, Inc., No. 19-4039 (6th Cir. Oct. 14, 2020; cert. pet. granted Nov. 5, 2021)]  MORE >>

SCOTUSblog

PBM Oversight, Insulin Cost-Sharing Provisions Among Build Back Better Act Updates

"This post focuses on a further revision released by the House Rules Committee on November 3 and summarizes changes relative to the October 28 draft. Where there are tweaks, most adjust the duration of the policy. The House also added not-previously-considered provisions related to cost sharing for insulin and oversight of pharmacy benefit managers (PBMs)."  MORE >>

Health Affairs Blog

CRS 'Insight' Report: Comparison of Selected Paid Leave Program Provisions Included in HR 5376 and in House Rules Committee Print 117-18 (PDF)

"[Title XIII, Subtitle A of the Build Back Better Act (HR 5376)], as introduced on September, 27 2021, proposed a new federal cash benefit for eligible individuals engaged in certain types of family and medical caregiving. A modified proposal was included in House Rules Committee Print 117-18 on November 3, 2021. [A table] compares selected provisions in these two proposals." [IN11794, Nov. 5, 2021]  MORE >>

Congressional Research Service [CRS]

Paid Leave and Prescription Drug Pricing Proposals Added to Budget Reconciliation Bill

"The updated [Rules Committee Print of the Build Back Better Act (HR 5376)] now also includes ... [1] Four weeks of paid family and medical leave for illness, the birth of a new child, or to take care of a sick family member.... [2] Prescription drug price reform that penalizes drug companies for raising prices faster than inflation for Medicare and employer plans."  MORE >>

HR Policy Association

Generalized Anxiety Disorder Disability Benefits: A Primer for Employees

"The most common mental health disorder, affecting nearly 30% of adults at some point in their lives, a generalized anxiety disorder, can be disabling.... This article will offer suggestions for how you can improve your likelihood of receiving short-term or long-term disability benefits due to generalized anxiety disorder."  MORE >>

DeBofsky Sherman Casciari Reynolds P.C.

[Opinion]

Comment Letter from P4ESC to Congress on Expansion of ACA Premium Tax Credit Included in 'Build Back Better Act' (PDF)

"[T]he special allowance of the PTC in circumstances where an employer has offered minimum essential coverage meeting the otherwise applicable affordability requirements of the ACA may have certain unintended, potentially negative consequences on employer risk pools and ripple through the entire system."  MORE >>

Partnership for Employer-Sponsored Coverage [P4ESC]

[Opinion]

Comment Letter from P4ESC to Congress on Proposed Civil Monetary Penalties for MHPAEA Violations (PDF)

"Civil monetary penalty enforcement could be used as a tool to impose network adequacy requirements by penalizing employers based on the raw number of mental health or substance use disorder providers in network.... [E]mployer networks consistently report that these providers ... decline to participate in our networks at reasonable rates.... Imposing penalties on plan sponsors cannot solve provider shortages."  MORE >>

Partnership for Employer-Sponsored Coverage [P4ESC]

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Premium Surcharge for Unvaccinated Spouses/Dependents

"I'm trying to better understand the potential HIPAA discount/surcharge issues where spouses and dependents are involved (setting aside ADA, GINA, etc. for the moment). Is it permissible to require all covered individuals (or perhaps at least spouses and adult dependent children) to be vaccinated to receive the discount (or avoid the surcharge)?"

BenefitsLink Message Boards

MHPAEA Comparative Analyses -- How Helpful Are Your TPAs?

"Are any of you working with any self-insured clients who are looking to their TPAs to provide MHAPEA comparative analyses as required by the CAA only to be rebuffed in their attempts? I am working with one client whose TPA is one of the large BCBS providers in the area and the TPA is not providing an analysis unless and until the DOL comes calling. I have other clients using other TPAs (including other BCBSs) who have been much more accommodating."

BenefitsLink Message Boards

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Enterprise Iron

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COVID-19 Relief for Health Plans: How Long Does it Last?

Mercer

2021 Year-End Preparation for Benefit Plans (PDF)

Ivins, Phillips & Barker

New OSHA ETS: What Paid Leave Must an Employer Provide an Employee to Obtain a COVID-19 Vaccine or Test?

FMLA Insights