"Updates applicable to the women's preventive services that must be covered without cost-sharing in plan years beginning on or after December 30, 2022, include [1] Counseling to prevent obesity in women aged 40 to 60 years with normal or overweight body mass index; [2] Double electric breast pumps, pump parts and maintenance, and breast milk storage supplies; [3] The full range of women's contraceptives listed in the recently updated FDA Birth Control Guide; [4] Screening for HIV infection for all adolescent and adult women aged 15 and older at least once during their lifetime, and risk assessment and prevention education beginning at age 13; and [5] Pre-pregnancy, prenatal, postpartum, and interpregnancy well-woman visits."  MORE >>

"PBMs initially were formed in 1968 to process claims and negotiate lower prices with drugmakers. Now, PBMs administer prescription drug plans for more than 266 million Americans who have health insurance. The Federal Trade Commission is expected to probe the PBM industry this year about the fairness of their reimbursement policies."  MORE >>

"[T]he court held that the arbitration procedures of the rule conflicted with the express terms of the No Surprises Act in violation of the Administrative Procedures Act (APA).... [This] decision, while a 'win' for providers, leaves the details of the arbitration process under the Act uncertain for now, as the agencies presumably go back to the proverbial drawing board." [Texas Medical Assoc. v. HHS, No. 21-0425 (E.D. Tex. Feb. 23, 2022)]  MORE >>

"At the moment, the QPA Presumption is vacated with nationwide effect. If no stay is issued and the district court's decision is not overturned, the IDR process may begin without the benefit of the QPA Presumption." [Texas Medical Assoc. v. HHS, No. 21-0425 (E.D. Tex. Feb. 23, 2022)]  MORE >>

"In an issue of first impression at the Circuit Court level, [the Second Circuit] held that California's statutory ban on discretionary clauses in insurances ... applies only to claims by California residents, and does not extend to claims by non-California residents under any circumstance -- even under policies delivered in California." [Mayer v. Ringler Assocs. Inc., No. 20-1281 (2d Cir. Aug. 12, 2021; cert. pet. denied Feb. 22, 2022)]  MORE >>

"Felix's case is unique because the employment at issue was for a predetermined term subject to reappointment, but it can serve as a reminder that employee protections under the state and federal laws aren't boundless." [Felix v. Town of Kingston, No. 19-1774 (1st Cir. Dec. 23, 2021; unpub.)]  MORE >>