"[T]he Enforcement Letters ... provide critical details regarding how the [No Surprises Act (NSA)] intersects with existing state laws and CMS's expectations regarding NSA enforcement in each state.... The diversity of pre-NSA state laws addressing surprise and balance billing ... has presented significant challenges for stakeholders attempting to comply in good faith with the NSA in addition to state requirements, particularly in areas where state and Federal law do not align perfectly."  As of February 11, 2022, CMS has not published Enforcement Letters for Alaska, Arizona, Illinois, Nevada, New York, Ohio, or Tennessee.]  MORE >>

"[CMS] recently proposed new federal minimum network standards and compliance procedures for insurers offering coverage through the marketplaces in 2023.... The numeric standards the administration has proposed are similar to (though generally more extensive than) those most states have already established for their individual markets."  MORE >>

"Each year, group health plan sponsors that provide prescription drug coverage to individuals eligible for Medicare Part D must disclose to CMS whether that coverage is 'creditable' or 'non-creditable.' The disclosure obligation applies to all plan sponsors that provide prescription drug coverage, even those that offer prescription drug coverage only to active employees and not to retirees. Calendar year plans must submit this year's disclosure by March 1, 2022."  MORE >>

"[E]mployers will not be able to simply restart policies and practices in 2022 they previously had in place to comply with the 2021 CPSL ... Because 2022 CPSL does not pre-empt local ordinances, employers may have compliance obligations under the state law and possibly up to four similar -- but not identical -- local ordinances in Long Beach, Los Angeles (City and County), and Oakland."  MORE >>

"At trial, the plaintiff argued that the employer prevented him from exercising his COBRA rights by backdating his retirement date and disregarding the date stated on the COBRA election notice. The court agreed with the plaintiff, determining that the employer's failure to correct the plaintiff's COBRA eligibility date was arbitrary and capricious." [Buford v. Gen. Motors, LLC, No. 16-14465 (E.D. Mich. Jan. 26, 2022)]  MORE >>

"The study examined data from 2018-2020 and found: [1] Costs per single treatment for drugs administered in hospitals were an average of $7,000 more than those purchased through specialty pharmacies. [2] Drugs administered in physician offices were an average of $1,400 higher. [3] Hospitals, on average, charged double the prices for the exact same drugs, compared to specialty pharmacies. [4] Prices were 22% higher in physicians' offices for the exact same drugs, on average."  MORE >>

"Telehealth has proven itself undeniably practical. However, ensuring its long-term survival will require ongoing work and revision, including broadband improvements, permanent Medicare reforms, Interstate Medical Licensure Compact participation and payment parity assurance."  MORE >>

"Mercer projects the 'required contribution percentage' that determines the affordability of employer-sponsored health coverage under the [ACA] will rise to 9.7% of an employee's household income -- or an applicable employer shared-responsibility (ESR) affordability safe harbor -- for the 2023 plan year. This marks an increase from the 2022 plan-year level of 9.61%.... Mercer also projects that the 2023 play-or-pay federal poverty line (FPL) affordability safe-harbor amount for calendar-year plans will increase to $109.85 per month -- a fairly significant hike from the 2022 amount of $103.15."  MORE >>

"A Post-Deductible HRA can be designed to increase consumerism and create a desired balance between employee out-of-pocket responsibility, claims utilization, and total premiums. The financial benefits can be greater in certain situations than others."  MORE >>

"Once the success threshold has been met, to determine whether a discretionary award of fees is warranted, courts apply a five-factor test ... factors that clearly and intentionally favor successful plaintiffs.... Increasingly, insurance companies are seeking attorney fee awards against claimants who are partially or wholly unsuccessful in overcoming deference and other substantive and procedural advantages to the plan decision makers and are thus unable to have a denial of benefits reversed. For the most part, courts continue to reject attorney fee applications from insurance companies that successfully defeat lawsuits seeking plan benefits."  MORE >>