62 pages. "This document proposes the methodology and data sources necessary to determine Federal payment amounts to be made for program year 2023 to States that elect to establish a Basic Health Program under the [ACA] to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Health Insurance Exchanges."  MORE >>

"Employers should work with their insurance carrier, TPAs or an actuary to determine if their prescription drug coverage is creditable based on these criteria. If the employer must make the determination itself, it may use the simplified method, depending on the plan's design. When a plan's design is not eligible for the simplified method, an actuarial determination must be made."  MORE >>

"Employees who have worked at least 680 hours over the 12-month period immediately preceding the date on which the leave is to begin are 'covered individuals' under the Act. Self-employed individuals may also elect to participate in the program.... Covered employers include any person or governmental authority that employs at least one individual in the state of Maryland. However, ... the funding requirements differ for employers with less than 15 employees."  MORE >>

"The court expressed concern about the legal consequence of Reliance's acceptance of Skelton's premium payments, pointing out that it had told Skelton she would not have to pay premiums until the coverage was approved, yet Reliance 'then took her premiums without approving her application -- profiting on its broken promise.' ... [T]he Eighth Circuit sent a powerful message to ERISA fiduciaries that they need to maintain strict procedures and guidelines in administering benefits, and that sloppiness or negligence will be punished." [Skelton v. Radisson Hotel Bloomington, No. 21-2641 (8th Cir. May 6, 2022)]  MORE >>

"Prices could become a bigger story if healthcare starts to catch up with the rest of the economy in terms of inflation. Analysts have floated out-of-network payment caps as one way to address hospital prices. There appears to be at least a small link between hospital prices and quality."  MORE >>

"Blue Cross Blue Shield Massachusetts' (BCBSMA) recent experience shows how behavioral science can help to achieve health system goals that rely on behavior change at low cost.... [H]health plans should explore this approach more, given that many continue to rely on a set of familiar tools: financial incentives for members and providers; streamlining choices; and targeted audits to prevent fraud, waste, and abuse."  MORE >>

15 pages. "While 86% of employers consider mental health, stress, and burnout top priorities for 2022, nearly half had not settled on a prevention strategy as recently as late January.... [E]mployers rate themselves 7.6 out of 10 for their mental health efforts, yet employees rate their employers just 4.4 out of 10, and only 20% of employees say their HR department has offered productive solutions when they have tried to discuss burnout."  MORE >>

"The Ninth Circuit found that ... the remand order was more than a purely procedural victory, even though the district court did not signal that Woolsey should be eligible for benefits.... Because the record was not fully developed, the district court was in no position to assess the merits of the claim. Lastly, the court found it of 'no consequence' that Woolsey's complaint did not expressly seek a remand because he alleged the relevant ERISA violations in his complaint and sought a remand in the alternative in his summary judgment motion." [Woolsey v. Aetna Life Ins. Co., No. 20-16885 (9th Cir. May 20, 2022; unpub.)]  MORE >>