"Carriers must cover OTC COVID-19 tests that meet the statutory criteria under section 6001(a)(1) of the FFCRA, including tests that have been authorized, cleared, or approved for use without the involvement of a health care provider.... Carriers must provide education and information resources to support FEHB covered individuals seeking OTC COVID-19 testing, including how to obtain OTC COVID-19 tests directly from their FEHB plan or designated sellers."  MORE >>

"Form 1094-C: [1] Be very sure that the 'Yes' box is checked on Line 23, column (a) to state that minimum essential coverage was offered for all 12 months.... [2] Know when to check the box on Line 22 for 'Qualifying Offer Method.' ... Form 1095-C: [3] Conduct a coding audit and know where to prioritize.... [4] Review for 'red flag' coding combinations on lines 14 and 16.... [5] Review for incomplete coding on lines 14 and 16.... [6] Make sure the safe harbor code reported on line 16 actually applies.... [7] Ensure the waiting period is coded correctly on lines 14 and 16."  MORE >>

"Given the uncertainty, employers implementing the testing option should be making a good-faith effort to comply with the ETS ... Employers must generally either require [1] all employees to be fully vaccinated (two weeks from the first dose of Johnson & Johnson vaccine or the second dose of Pfizer or Moderna vaccine) or [2] all unvaccinated employees to undergo weekly testing and wear face coverings."  MORE >>

"[DOL, HHS, and the Treasury Department] have issued FAQs ... [which] address coverage of follow-up colonoscopies after a positive stool-based or direct visualization screening test under US Preventive Services Task Force recommendations. The FAQs also announce the Departments' efforts to investigate and enforce reported noncompliance with the ACA's contraceptives mandate, which generally requires coverage of contraceptives that are approved by the [FDA]."  MORE >>

"Presumably, once established, a direct coverage program would result in administrative cost savings in addition to cost savings associated with the cap on reimbursement. However, it may be challenging for plans and issuers to establish this type of program quickly, particularly if the availability of OTC COVID-19 tests continues to be limited."  MORE >>

"Plans may provide education and information resources to support participants who are seeking OTC COVID-19 tests, as long as the resources make clear that testing is available at no cost and the information is consistent with the test's emergency use authorization."  MORE >>

"CMS is also defining the term 'price concession' for the first time to include all forms of discounts and direct or indirect subsidies or rebates that serve to reduce the costs incurred under Part D plans by Part D sponsors.... [CMS] expects the changes would reduce beneficiary costs by about 2% or $21.3 billion over 10 years by requiring these pharmacy price concessions to be included in the negotiated price."  MORE >>

"[M]any Americans have put off routine health exams and tests such as mammograms. Or they might not be able to schedule them amid a healthcare system stressed with COVID-19 patients.... Fitch data shows little change in profitability in the health insurance sector from 2019 to 2020, [an analyst] explained, 'which is amazing really, considering that, as you went into 2020, the industry did not know that we were going to have a pandemic. Pricing is typically set around six months before the prices actually take effect.' "  MORE >>

"A coronavirus pandemic which lasts five years, another pandemic in a decade, and ever more transmissible variants are among the scenarios life insurers are predicting after COVID-19 claims jumped more than expected in 2021. The global life insurance industry was hit with reported claims due to COVID-19 of $5.5 billion in the first nine months of 2021 versus $3.5 billion for the whole of 2020[.]"  MORE >>

22 pages. "A key issue facing the American healthcare system is the impact of social needs, social risks, and social determinants of health (SDoH) on healthcare.... For employers, understanding these impacts within the context of a population health strategy can foster a broader approach to closing gaps in care and in access to services across employee populations. This report identifies a process model to enhance employee and community well-being."  MORE >>

"[The authors] explore the assumptions that underly 'shared surplus' proposals for allocating economic value of rare gene therapies and identify limitations associated with this approach. [They] then describe three fundamental questions about value and examine how 'leakage' can occur when defining and measuring the value of health care treatments [and] conclude with recommendations to address leakage, including adoption of a societal perspective and new methodological approaches to value assessment."  MORE >>