"[T]he Ninth Circuit reversed the district court's order requiring UBH to reprocess more than 60,000 claims that had initially been denied for not meeting UBH's medical necessity guidelines. The memorandum decision was surprisingly short -- and that has both positive and negative implications for mental health parity litigation." [Wit, et al. v. United Behavioral Health, Nos. 20-17363, 21-15193, 20-17364, 21-15194 (9th Cir. Mar. 22, 2022; unpub.)]  MORE >>

"[T]he First Circuit Court of Appeals determined that a health plan's blanket assertion of compliance with the Parity Act is not enough for the case to be dismissed where a participant plausibly alleges that: [1] as written, the plan document covers some habilitative services for physical conditions, but bars such services for mental health conditions, and [2] the plan's denial of coverage for habilitative services was based on a mental health diagnosis, without a medical necessity review or confirmation of habilitative purpose of the services." [N.R. v. Raytheon Co., No. 20-1639 (1st Cir. Jan. 31, 2022)]  MORE >>

"The challenge is one of implementation; getting workers to focus on the differences in contributions, deductibles, employer support in the form of contributions to HSAs and out of pocket expense maximums. The implementation challenge often arises when a plan sponsor/employer simply introduces an HSA-capable coverage as an alternative to a traditional PPO and/or HMO option, without any education or transitions."  MORE >>

"Why are HDHP's more favorable for employees? The answer is not that employers are differentially providing more premium support.... [On] average firms contribute approximately the same total dollar amount toward premiums for both HDHP and traditional health plans types. However, many employers also contribute additional funds for employee's health savings accounts (HSAs) which are linked to the HDHPs."  MORE >>

"While Federal law currently mandates that all group health plans and group and individual health insurance covered by the [ACA] cover FDA-approved initial vaccination and first booster vaccinations administered in accordance with recommendations of the Advisory Committee on Immunization Practices (ACIP), the ACIP as of now has not amended its COVID-19 vaccination recommendations to include the FDA second boosters approved by the FDA."  MORE >>

"A QSPP is an agreement that sets company policy before a disability occurs. It establishes who should be included, how much salary they will be paid, when payments start, and how long the payments will last.... This legal document, recognized by the IRS, allows your business to provide income to select employees even if they're out of work for years. With a QSPP in place, you can pay the employee's salary and deduct their wages from the company's taxes just as you would for a regular full-time employee."  MORE >>

"The issue of increasing drug prices hindering patient access is not new. In fact, more than the past decade has been marked by major drug price hikes. But the spotlight has historically been on drug manufacturers and not so much on the role of health insurers, whether public or private.... Yet payers frequently review the medications they cover and adjust their coverage of these medications."  MORE >>

"Can people with mental health care coverage easily access services? [GAO] looked at challenges they experience, and federal efforts to improve access to mental health services. [GAO] found that people may have difficulty finding in-network mental health providers that accept new patients. Representatives from 19 of the 29 stakeholder organizations we contacted said low provider reimbursement rates contributed to this problem." [GAO-22-104597, published Mar. 29, 2022, released Mar. 30, 2022]  MORE >>

"In addition to specific audit steps, there are new required management representations and responsibilities (particularly in determining that an entity is a qualifying institution for which an ERISA Section 103(a)(3)(C) audit may be performed)."  MORE >>

"Not only are plan amendments and meeting minutes vital for documenting adherence with ERISA and demonstrating meeting fiduciary obligations under ERISA, these documents also provide your auditors with information they will need to properly plan and execute your plan audit. Maintaining these documents and providing them early to your auditors will provide for a smoother and more efficient audit."  MORE >>