"[OCR] is issuing this Request for Information (RFI) to solicit public comment on certain provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, namely: The consideration of recognized security practices of covered entities and business associates when OCR makes determinations regarding fines, audits, and remedies to resolve potential violations of the [HIPAA] Security Rule; and the distribution to harmed individuals of a percentage of civil money penalties (CMPs) or monetary settlements collected pursuant to the HITECH Act[.]"  MORE >>

30 pages; updated Apr. 6, 2022. "As safe and effective COVID-19 vaccines become available, CMS is issuing this toolkit to help health insurance issuers and Medicare Advantage plans identify the issues that need to be considered and addressed in order to provide coverage and reimbursement for vaccine administration."  MORE >>

"These parameters will be used by group health plan sponsors to determine whether their plans' prescription drug coverage is creditable for 2023. The information is needed for required disclosures to Part D eligible individuals and to CMS." [See CMS Announcement and Fact Sheet.]  MORE >>

"HHS's Office for Civil Rights (OCR) has begun implementing 2021 legislation that requires the agency, in enforcing HIPAA, to consider whether HIPAA covered entities (CEs) and business associates (BAs) have implemented and applied certain recognized security practices -- including with regard to cybersecurity ... As an initial step in this process, HHS has issued a request for information (RFI) concerning CEs' and BAs' voluntary implementation of recognized security practices[.]"  MORE >>

"[S]ome employers may see a shift from family coverage to self-only coverage if family members become eligible for PTCs and prefer QHP coverage over employer coverage. Applicable large employers may also foresee additional Code Section 6056 reporting obligations since, to administer family-member PTCs, the IRS would need information on the required employee contribution for family coverage and whether the coverage provides minimum value."  MORE >>

"The COBRA rules do not provide a definition of what qualifies as 'gross misconduct' for purposes of this exception. The court cases that have addressed the issue have often come to an exceptionally restrictive interpretation of the term. In other words, it has proven very difficult for employers to rely on the gross misconduct exception to deny an offer of COBRA."  MORE >>

18 presentation slides. Topics: [1] Washington update; [2] ACA 1557 and HSA/telehealth issues; [3] MHPAEA litigation update; [4] State PBM legislation; and [5] ERISA plan assets: recent issues and concerns.  MORE >>

"There's no national data to indicate how often patients or their families receive medical bills that were previously paid or forgiven, but hospital billing experts say they frequently see it happen. Patients receive bills for claims their insurers already paid. A reminder statement arrives even after a patient submitted payment."  MORE >>

"At least 1 in 6 patients who have health insurance will receive a surprise medical bill from a provider or specialist who treated them.... Most studies on surprise medical bills have found that these bills were most likely to come from emergency medicine physicians, anesthesiologists, radiologists, and pathologists.... Every year, the outrageous out-of-network bills from a subset of specialty physicians result in $40 billion in additional spending in employer-provided coverage alone."  MORE >>

"Like half of all Americans, many food and beverage workers live paycheck to paycheck. They are also among the 80% of workers who want benefits geared to their circumstances and age.6 Funded by the employer or not, voluntary benefits have value to workers in this highly competitive labor market."  MORE >>

"In the Results Memo, Appendix B provides a table indicating which state market risk pools would have 2020 benefit year risk adjustment transfers impacted by 2019 benefit year HHS-RADV (due to the presence of at least one error rate outlier in the state market risk pool).... [T]his supplement provides a second table indicating the estimated weighted average risk score adjustment factors by state market risk pool based on the 2019 benefit year HHS-RADV results. These numbers are for reference purposes only and do not reflect the actual weighted average risk scores that will be applied to 2020 benefit year risk adjustment transfers."  MORE >>

"[T]he employer-sponsored market has been slow to adopt accountable care models relative to public programs, leaving a majority of Americans stuck in a system that rewards more care, rather than rewarding improvements in health. With more adoption of accountable care models and providers working in a value-oriented framework, employers may be able to improve their employees' health outcomes while reducing their out-of-pocket costs."  MORE >>

"These penalties cover a wide range of benefit plan compliance failures. The DOL has discretion to impose lower penalties in some instances -- such as pursuant to programs designed to encourage Form 5500 filing -- so not all violations will result in the maximum permitted penalty. And while relief granted in connection with the COVID-19 public health emergency allows more time to provide certain disclosures, penalties could potentially be triggered if the terms of that relief are not met."  MORE >>