"[E]mployers who have withheld the payroll tax from employees and who have not sent the amounts to the State will need to issue refunds within 120 days of the collection date. To the extent amounts have been sent to the State, the State will also make refunds within this 120 day period. Employers who delayed withholding the payroll tax will not ... need to start implementing the tax until 2023."  MORE >>

"Some pharmacy contracts may have terms that include contingent prices based on performance or other metrics. In such cases, the net price must reflect the best possible reductions, meaning it is possible the pharmacy price concessions at point of sale could create a negative [direct and indirect remuneration (DIR)] once reconciled at year-end."  MORE >>

"The terms of the FFCRA and CARES Act support finding an implied private right of action to enforce the right to reimbursement for COVID-19 testing against [group health plans] and administrators ... A private right of action to recover the mandated reimbursement is fully consistent with the legislative scheme ... Diagnostic Affiliates has pled sufficient factual allegations to support its standing to assert ERISA claims on behalf of the patients it served by pleading that it has obtained many assignments from patient members of the plans." [Diagnostic Affiliates of Northeast Houston, LLC v. United Healthcare Services, Inc., No. 21-0131 (N.D. Tex. Jan. 18, 2022)]  MORE >>

"[The Independent Dispute Resolution (IDR)] entity is required to begin with the presumption that the qualifying payment amount (QPA) is the appropriate amount. In general, the QPA is the Plan's median contracted rate for the same or similar service in the specific geographic area. This presumption is the basis of the controversy as the Out-Of-Network Providers deem a Plan's median contracted rate to be an inappropriate starting point."  MORE >>

"The results described in the 2022 Report confirm that many plan sponsors cannot prove their insurers and TPAs are operating plans in compliance with MHPAEA's parity requirements and there are common areas of non-compliance."  MORE >>

"[D]ata captured in consumer-directed health plans such as FSAs, HSAs and HRAs can provide a 360-degree view of the individual's health. Complemented with information available to them as payers, this makes it possible to guide the individual to more effective care.... To take this approach, however, self-funded employers will need to reevaluate the systems through which their CDH plans are provided."  MORE >>

"Among the drug pricing developments to watch in 2022, those at the top include legislation that would allow Medicare price negotiation and alter antitrust rules for the pharmaceutical industry, Federal Trade Commission rulemaking on unfair methods of competition, and court rulings on the federal 340B drug pricing program and so-called 'patent thickets.' Continuing state legislative activity on a wide range of issues, such as price transparency and drug importation, merits a close eye as well."  MORE >>

"Health plan sponsors can influence SDoH by providing health and financial security through fair and equitable hiring practices, compensation and career development, an inclusive work culture and affordable benefits that include advocacy and navigation support. When employers do not act to address these factors, they may lose the ability to enhance worker health and ultimately risk unfavorable impacts to employee productivity and business results."  MORE >>

38 pages. "[Oregon Health Authority (OHA) and the Department of Consumer and Business Services (DCBS)] seek to develop an affordable, comprehensive, on-Marketplace public option that has low cost-sharing and robust benefits, and that advances many of the State’s broader health equity and cost containment goals. ... The State is pursuing a multifaceted strategy to eliminate health inequities in Oregon, and the public option can be a key component of achieving that goal by implementing an affordable and equitable coverage option that can effectively close the remaining coverage gap."  MORE >>

"[The] letter urges CMS not to implement network adequacy standards related to emergency physicians because doing so would increase patient out-of-pocket costs and premiums without improving patient access."  MORE >>

"If you're seeking out or evaluating a job offer, here are some benefits that could be of great value to you.... [1] Paid time off ... [2] Subsidized or free health insurance ... [3] Matching dollars for your retirement plan ... [4] Gym or fitness equipment subsidies."  MORE >>