"The No Surprises Rules also introduce a negotiation and dispute resolution process for situations where the health plan and provider do not agree that the plan's ordinary payment is appropriate. The rules set a strong presumption as to the amount ... The rules ... [include] information that plans will need to provide to participants about the expected costs and benefits for a service subject to the rules. This requirement is delayed, pending further guidance."  MORE >>

"In addition to ensuring the updated preventative health guidelines are implemented, plan sponsors should work with their third-party administrator or insurer to develop a process for coverage of OTC COVID-19 tests and to develop procedures to reduce the risk of participant fraud."  MORE >>

"[1] For self-funded plans, will the plan seek to provide coverage through a direct arrangement and rely on the safe harbor? ... [2] How will plans communicate these changes to participants? ... [3] How will self-funded plans track the number of tests provided compared to the allowable limits set by the FAQs? ... [4] Will the self-funded plans require an attestation from participants as part of the reimbursement process? ... [5] What will self-funded plans require as documentation as part of the reimbursement process?"  MORE >>

"Under its temporary enforcement policy, the DOL will treat a provider of brokerage or consulting services to a group health plan as having made the required disclosures to a responsible plan fiduciary if the disclosures are made in accordance with a reasonable good faith interpretation of ERISA Section 408(b)(2)(B)."  MORE >>

"By [renewing the Emergency Order] for another 90 days, [HHS] preserved major flexibilities for providers on telehealth and other waivers intended to help combat the virus ... The emergency ... also enables states and counties to waive certain requirements if they have issued their own emergencies."  MORE >>

"The successor of a bankrupt mental-health and substance-abuse treatment provider can sue Cigna for $8.6 million in unpaid benefits but can't seek damages for fraud ... The 9th U.S. Circuit Court of Appeals revived most of a lawsuit brought by Bristol SL Holdings Inc. -- a company formed by the principals of Chapter 11 debtor Safe Haven Inc., with the bankruptcy court's approval -- to collect on the unpaid claims that Safe Haven blamed for forcing it into bankruptcy in 2017." [Bristol SL Holdings Inc. v. Cigna Health and Life Ins. Co., No. 20-56122 (9th Cir. Jan. 13, 2022; also companion opinion, unpub.)  MORE >>