"While access to mental health services is the primary driver for the Departments, it seems clear from these recommendations that the Departments would like to increase their authority by expanding enforcement jurisdiction and directly auditing insurer and TPA practices."  MORE >>

"The Departments reported that none of the comparative analyses reviewed to date have contained sufficient information upon initial receipt to satisfy the Departments' expectations. The Report suggests that this reflects a lack of motivation or effort by health plans to undertake the work necessary to comply with the substantive requirements of MHPAEA and the documentation requirements of the CAA.... The Report describes auditing efforts by the Departments that represent a significant increase in the volume, intensity, and sophistication of investigations into parity compliance compared to prior years."  MORE >>

"When providing coverage of at-home tests through a direct-to-consumer arrangement, group health plans must cover reasonable shipping costs and sales tax in a manner consistent with other items or products provided by the group health plan via mail order.... The direct coverage arrangement does not have to cover every eligible test from every manufacturer."  MORE >>

"On Friday, February 4, 2022 ... the Departments released ... FAQs Part 52, which clarifies their prior guidance on the new coverage requirements.... [T]he new guidance provides some additional flexibility for plans trying to meet the 'safe harbor' that allows them to limit reimbursement to $12 per test (or, the cost of the test, if less) for tests purchased from non-network providers. The new guidance also answers a number of stakeholder questions about the coverage mandate outlined in FAQs Part 51."  MORE >>

32 pages. "The [Defense Health Agency (DHA)] improperly paid claims for FY 2020 telehealth services.... These improper payments occurred because the DHA did not have controls in place to prevent payment when the claims for originating site and distant site services were performed by the same provider, or when the beneficiary was not present at the originating site.... As a result of improperly paid telehealth claims, ... the DHA potentially overpaid health care providers for originating site fees by $620,162 from October 2019 through June 2020."  MORE >>

"A qualified HSA funding distribution (QHFD) allows for the transfer of funds from an IRA to an HSA. The rollover is tax-free. Moving funds from an IRA to an HSA may have more tax advantages than saving in an IRA alone."  MORE >>