"Inflation adjustments released by [HHS] apply to penalties assessed on or after March 17, 2022, for violations occurring on or after Nov. 2, 2015. These penalty increases come on the heels of the last adjustment for penalties assessed on or after Nov. 15, 2021."  MORE >>

This document summarizes key dates for calendar year 2022 regarding activities and policies that are outlined in other documents.  MORE >>

"[In] 2019, the [district] court issued a 106-page decision, finding that UBH had violated ERISA by applying 'unreasonable' standards allegedly not consistent with generally accepted standards of care [GASC] ... The Ninth Circuit, however, decided that UBH had properly exercised its discretion ... and that the underlying health plans did not require consistency with the GASC, only that they not be inconsistent.... Many courts have relied upon Wit's reasoning to deny United any deference in benefit decisions, allow broad discovery, and even award benefits. The Ninth Circuit's decision will likely bring an end to that." [Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]  MORE >>

"After encountering pushback from insurers and claims administrators, out of network providers have sued to recover reimbursement for thousands of claims, primarily arguing that the CARES Act provides them with a private cause of action for reimbursement at the at 'cash price' they listed on their websites.... [One District Court] rejected that argument, pointing, among other things, to the absence of Congressional intent for a private remedy." [Murphy Med. Assocs., LLC. v. Cigna Health & Life Ins. Co., No. 20-1675 (D. Conn. Mar. 11, 2022)]  MORE >>

"[T]he Fifth Circuit upheld the lower court's ruling that HHS's interpretation of 42 US Code Section 18063 is entitled to Chevron deference because Congress delegated development of the methodology to HHS, which prompts courts to adopt 'a deferential standard of review' giving 'considerable weight to HHS's judgment.' " [Vista Health Plan, Inc. v. HHS, No. 20-50963(5th Cir. Mar. 17, 2022)]  MORE >>

"Combining data from the first four years of the California ACA marketplace with a model of insurance demand, cost, and insurers' competition, [the author quantifies] the impact of alternative subsidy designs on premiums, enrollment, costs, public spending, and consumer surplus. Younger individuals are more price sensitive and cheaper to cover. Increasing subsidies to this group would make all buyers better off, increase market participation, and lower average costs and average subsidies."  MORE >>

"[L]eaders of high-performing organizations think expansively and incorporate company stock or other long-term incentive programs, career growth initiatives, retirement and wealth-building benefits, flexible work, voluntary benefits, skill building, caregiving support, and other programs into their core offering as appropriate, supported by a strong employee experience."  MORE >>

"Courts that have sealed claim files in ERISA cases have done so thoughtfully and with good reason....  The most meticulous effort to scrub such information from claim records is beyond a herculean task and is close to impossible ...  Identity theft is rampant nowadays, and the ease with which court records can be downloaded heightens such risks."  MORE >>