"2022 will bring the greatest number of group health plan compliance changes since 2014, when the bulk of the [ACA's] provisions went into effect. The Biden Administration delayed a few requirements that were slated to take effect this year, and a few more are now subject to 'good-faith compliance' standards.... [1] Group health plan compensation disclosure requirements ... [2] Surprise billing protections ... [3] Health coverage identification cards ... [4] Employer reporting changes ... [5] Online data files ... [6] Medical and Rx claims data reporting."  MORE >>

"Beginning in 2022, group health plans, insurance issuers and providers must take specific steps to improve provider directories and bear certain costs when inaccurate directories cause patients to incur out-of-network charges.... [G]roup health plans and issuers [must] satisfy each requirement listed in [a chart which also] includes any CAA details about each requirement, as well as open questions that hopefully will be addressed in future guidance."  MORE >>

"The determination of whether a service provider meets the definition of a 'covered service provider' depends on the facts of the particular situation. Any service provider should be prepared if audited to explain how it concluded that it is not a covered service provider consistent with a reasonable good faith interpretation of the statute.... The [DOL] clarified that the ERISA Section 408(b)(2)(B) requirement applies to both large and small group health plans."  MORE >>

"DOL will likely be adding compliance with ERISA section 408(b)(2)(B) to its enforcement activities both for plan sponsors and for service providers of brokerage and consulting services to ERISA plans in the near term. As a result, plan service providers as well as responsible plan fiduciaries should be prepared to articulate a reasonable and good faith basis for their conclusions in connection with implementing practices regarding section 408(b)(2)(B) disclosures."  MORE >>

"New rules apply to health plan service provider compensation in 2022 that employers must know and be equipped to manage. This e-alert provides employers with background on these new rules, describes the new rules from the employer's perspective and suggests an employer action plan for 2022."  MORE >>

"[CMS] has updated its external review procedures under the [ACA] to address issues involving surprise medical billing under the No Surprises Act (NSA)  ... CMS's guidance addresses state-law external review procedures that cannot accommodate external reviews of NSA-related adverse benefit decisions involving surprise billing. The requirement to provide for external review of surprise medical billing matters, as added by the NSA, is effective for plan years beginning on or after January 1, 2022."  MORE >>

"After an employee has taken protected leave under FMLA or CFRA, that employee is entitled to return to their job or an equivalent job, subject to very limited exceptions. Commonly, an employee requests continued leave as an alternative to reinstatement after protected leave has expired. Employers should exercise extreme caution at this critical junction to prevent litigation."  MORE >>

"In its Notice of Adoption, NYSDOL discussed over 25 categories of public comments it received in response to the proposed regulations, but declined to revise the regulations based on those comments.... [E]mployers should take note of a few key points[.]"  MORE >>

"The voter-approved law ... will provide eligible employees with partial wage replacement for 12-16 weeks of leave, depending on the circumstances. Employees will be able to take paid leave for many of the same reasons permitted under the federal [FMLA]. The program also will extend paid leave so victims of domestic violence, sexual assault or stalking can handle related issues."  MORE >>

"DMP sued the [DOL] in October 2019, a year after it sought an advisory opinion that would allow it to market the plans as compliant with [ERISA] ... [DOL Advisory Opinion 2020-01A] said agreeing to be tracked online did not create any employment relationship recognized by ERISA. U.S. District Judge Reed O'Connor disagreed, saying DMP's thousands of health-plan purchasers are clearly ERISA-eligible 'working owners' who have a stake in DMP and actively provide services to it." [Data Marketing Partnership LP v. DOL, No. 19-800 (N.D. Tex. Sep. 28, 2020; appeal to 5th Cir. No. 20-11179; oral arg. Jan. 5, 2022)  MORE >>

"With new surprise billing regulations in place, providers should ensure they have efficient processes for gauging whether a patient is in-network. For some providers, the task may prove to be more trouble than it's worth in terms of opportunities to balance-bill patients. The new regulations make communication between providers and insurers even more important."  MORE >>

"[1] Choose the right type of deductible.... [2] Set the right attachment point.... [3] Establish a reasonable coverage period.... [4] Negotiate lasering.... [5] Ensure that the stop-loss policy and plan document align."  MORE >>

"One of the more significant changes in the standard is the introduction of the ERISA Section 103(a)(c)(3) audit ... [which] will provide a two-pronged opinion covering the audit and whether the certified investment information contained in the financial statements agrees to the certification. In addition, all ERISA audit reports ... will have expanded wording relating to both auditor responsibilities and management responsibilities."  MORE >>

"The final changes are limited to the changes that implement the SECURE Act provision that amended ERISA Section 103(g) to require certain MEPs, including PEPs, to include participating employer information with their annual returns. The final changes also clarify that multiple employer welfare arrangements (MEWAs) will still be required to report participating employer information."  MORE >>