"Though the MHPAEA already required group health plans and insurers to perform an analysis of [non-quantitative treatment limitations (NQTLs)], the CAA's requirement to produce written documentation of the comparative analysis is new and bolsters the ... increasing focus and ongoing commitment to MHPAEA enforcement [by DOL, HHS and IRS]. Due to the time constraints and potential penalties, employer-sponsors of self-insured health plans should focus on understanding this complex new requirement and prioritize their next steps to ensure compliance."  MORE >>

"A service provider should document the services it will provide and categorize and describe all the compensation that it will receive with respect to its services. If a service provider concludes that it is not required to make the disclosure, it should document that analysis and be prepared to defend its decision in the event the DOL examines the service provider."  MORE >>

"[The] proposed regulations would make permanent an automatic 30-day extension for issuing Forms 1095-B and 1095-C to covered individuals and employees, which would otherwise be due by January 31.... While the proposed regulations technically would become effective for coverage in calendar years beginning January 1, 2022, the IRS has indicated that reporting entities may rely on them starting with the reports due for 2021."  MORE >>

65 pages; rev. Jan. 6, 2022. This publication has been updated to include: [1] New York guidance clarifying that the state"s paid vaccination leave requirement applies to booster shots. [2] New York City and Washington, DC, have passed laws requiring paid vaccination time for employees and their children. [3] The California Occupational Safety and Health Standards Board has revised its workplace exclusion standards for employees who have had close contact with an infected person.  MORE >>

"This proposed rule would revise the MA and Part D regulations related to marketing and communications, the criteria used to review applications for new or expanded MA and Part D plans, quality ratings for MA and Part D plans, provider network adequacy requirements, medical loss ratio reporting, special requirements during disasters or public emergencies, and the use of pharmacy price concessions to reduce beneficiary out of pocket costs for prescription drugs under Part D."  MORE >>

"[B]oth average and median [actuarial values (AV)] were about 83 percent in each year from 2013 -- prior to the implementation of the major coverage provisions of the ACA -- to 2019.... Preferred provider organization (PPO) and point of service (POS) enrollees saw an average AV of 85 percent and 84 percent, respectively."  MORE >>

"This past year was filled with news in the prescription drug policy area, from the [FDA's] most controversial drug approval in many years to ongoing discussions in Congress over drug pricing reform. Through it all, the importance of responding to the COVID-19 pandemic has remained at the forefront of these challenges."  MORE >>

"Attorneys who battled United Behavioral Health for six years on behalf of class members wrongly denied mental health coverage claims were awarded more than $20 million in fees and costs ... The ruling comes more than a year after the court ordered UBH to reprocess thousands of wrongly denied mental health coverage claims." [Wit v. United Behavioral Health, No. 14-2346 (N.D. Cal. Jan. 5, 2022]]  MORE >>

"Prudential, MasterCard's life insurance carrier, denied Delker's claim for benefits beyond one year of salary because MasterCard did not pay the premiums for the additional two years of salary. MasterCard then took the position that Julie was entitled to 'credits' based on her hire date to elect the additional life insurance but that she had failed to make the election.... The Eighth Circuit concluded that Delker plausibly alleged that his wife elected a total amount of three times her salary in life insurance, for which MasterCard promised to pay premiums.' [Delker v. MasterCard Int'l, Inc., No. 20-3600 (8th Cir. Jan. 5, 2022)]  MORE >>

"Auditing standard SAS 136 ... [adds] new procedures to CPAs' audits beginning December 15, 2021. The burden for producing the added plan-related documentation required will likely fall to employers' human resources departments. SAS 136 transfers a significant amount of liability for an audit's accuracy from an auditor to a plan's fiduciaries, increasing the need for error-free payroll files and impeccable compliance in areas like compensation, distributions, and vendors' fees."  MORE >>