Updated Apr. 29, 2022. "HHS will designate the telehealth CPT service codes, including telephone-only service codes.... as valid for 2022 benefit year risk adjustment data submissions for the HHS-operated program, subject to applicable state law requirements."  MORE >>

"All of the dollar limits currently in effect for 2022 will change for 2023, with [one] exception ... The HSA catch-up contribution for individuals ages 55 and older will not change as it is not subject to cost-of-living adjustments. The table ]in this article] compares the applicable dollar limits for HSAs, HDHPs and excepted benefit HRAs for 2022 and 2023."  MORE >>

"[ACA FAQs Part 53 provide] a safe harbor for disclosing in-network healthcare costs that cannot be expressed as a dollar amount. They also serve as a timely reminder of the pending July 1, 2022, deadline to begin enforcing the Final Rules.... Plan sponsors should remember that these machine-readable files must be posted on a public website."  MORE >>

"The transparency rules do set forth protections for insured arrangements when the group health plan requires the insurer to provide such information via a written agreement. If insurer fails to comply, then the insurer violates transparency disclosure requirements, not the group health plan.... [A self-funded] group health plan ... can enter into a written agreement requiring the TPA to provide the information. However, the plan is still responsible if the TPA fails to comply. Therefore, it is imperative to have an indemnification agreement with the TPA."  MORE >>

"The [ACA] instituted several mandatory national payment reforms through the Medicare program and created the Center for Medicare and Medicaid Innovation (CMMI) ... to develop, test, and promote innovative payment and delivery models.... In these first 10 years, six of the 50 models launched by CMMI yielded statistically significant savings."  MORE >>

"8% of plans are currently using alternative funding models, while 31% are exploring [their] use ... 50% of employers are aware of new to market formulary blocks. 20% of plans can track patient treatment delays due to new to market formulary blocks ... 17% of plans feel prepared to make coverage decisions on new disease-modifying Alzheimer's drugs ... 92% of plans receive rebates under the pharmacy benefit."  MORE >>

"Individual plaintiffs' ERISA Section 502(a)(2) claims for alleged individualized harm to their respective retirement accounts are derivative and 'belong,' in the first instance, to the plan. The Sixth Circuit joined several other federal courts in holding that individual plaintiffs pursuing ERISA Section 502(a)(2) claims on behalf of a defined contribution plan may not be compelled to arbitrate those claims absent evidence the plan has consented to arbitration." [Hawkins v. Cintas Corp., No. 21-3156 (6th Cir. Apr. 27, 2022)]  MORE >>