"IRS regulations provide three options for determining the average number of covered lives: actual count, snapshot and Form 5500 method.... [T]he PCORI fee must be paid by the plan sponsor; it cannot be paid in whole or part by participant contributions or from a trust holding ERISA plan assets."  MORE >>

"Employers ... should try to address mental health issues caused or exacerbated by the pandemic, both to support employees, and also to reduce the risk of workplace claims.... [S]upervisors and managers should be trained on what they should and should not ask of employees, the importance of maintaining the confidentiality of medical information that is shared with them and the importance of not sharing why a given employee is receiving a particular accommodation."  MORE >>

46 pages. "This report provides an overview of PFML in the United States, summarizes state-level family and medical leave insurance program provisions, reviews PFML policies in other advanced-economy countries, and describes recent federal legislative action to increase access to paid family leave." [R44935 updated Jun. 13, 2022]  MORE >>

"Employers have just over a year to address their compliance obligations under Minnesota's fourth local paid sick and safe time mandate, which does not take effect until July 1, 2023. The Bloomington ordinance is a near replica of the Minneapolis Sick and Safe Time Ordinance, which has been in effect since July 1, 2017. It generally requires employers to provide certain employees in Bloomington with up to 48 hours of paid sick and safe time per year."  MORE >>

"The court found that there was no evidence that [the patient] could not have received certain care and treatment at the hospital in Lima and that the hospitals' plan of care was similar.... [T]he court found that the independent review organization's (IRO) denial of benefits does not require de novo review because 'the IRO's non-binding affirmance of Blue Cross's denial of benefits did not negate Blue Cross's discretion.' " [Continental Med. Transp. LLC v. Health Care Serv. Corp., No. 21-35481 (9th Cir. June 7, 2022; unpub.)]  MORE >>

18 pages. "Despite the acceptance and prevalence of domestic partner benefits, complex legal, tax, administration and other compliance issues come with the territory.... This GRIST summarizes the major issues, provides a tax-dependent flowchart and a domestic partner checklist for employers, and includes two charts summarizing applicable state laws"  MORE >>

"[W]ellness travel ... [comprised] 44% of the tourism market in 2022 ... Contributing to that growth is an expanded idea of wellness tourism that includes health coaching, medical-grade spa treatments, fitness classes and special food menus. Guests might design their own itineraries to meet fitness goals, help lose weight or improve their mindfulness through meditation and coaching."  MORE >>

"The administrative nightmare that is fee-for-service, third-party reimbursement can quickly increase operating expenses, require real revenue cycle management and move companies into a far greater degree of regulatory oversight and scrutiny.... [1] Manage for your payer's expectations ... [2] Welcome to your new, rigorously regulated environment ... [3] You may be paid more, but when?"  MORE >>

"Under the [ACA], many preventive services -- such as breast and colorectal cancer screening -- are covered at no cost.... But if a screening returns an abnormal result and a health care provider orders more testing to figure out what's wrong, patients may be on the hook for hundreds or even thousands of dollars for diagnostic services."  MORE >>

"Capital Rx's clearinghouse is based on the publicly available database maintained by the [CMS] known as the National Average Drug Acquisition Cost. Updated weekly, it offers a snapshot of how much a basket of pharmacies across the country are paying manufacturers and wholesalers to purchase drugs. Any pharmacy that contracts with Capital Rx agrees to charge customers the NADAC price or lower."  MORE >>