"[G]roup health plans subject to the TiC Final Rules must disclose through three separate [machine-readable files (MRFs)] the following pricing information for each coverage option: [1] In-network provider negotiated rates for all items and covered services, [2] Historical out-of-network allowed amounts for providers, and [3] In-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy-location level The MRFs must be updated on a monthly basis and must clearly state the date the files were last updated.... [O]nly the in-network and out-of-network MRFs must be made publicly available by July 1, 2022."  MORE >>

"The 'Employee Commuter Transit Benefit Programs,' would apply to employers with 50 or more 'covered employees.' Covered employees must be offered a pre-tax payroll deduction for mass transit expenses, qualified bicycle expenses, or an employer-paid benefit for a fare instrument.... Once implemented into law, this ordinance would take effect on December 31, 2022."  MORE >>

"The Bloomington Earned Sick and Safe Leave Ordinance takes effect on July 1, 2023, and will require employers with six or more employees to provide their Bloomington employees with one hour of paid sick and safe leave for every thirty hours worked, up to a maximum of forty-eight hours per year. Employees will be allowed to carry over unused sick and safe leave from one calendar year to the next, up to a maximum of eighty hours."  MORE >>

"Arbiters in Texas have tended to issue judgments that mirror the median in-network rate even with guidance instructing them to consider other factors.... Initially, [HHS] issued regulations requiring arbiters to primarily consider the median in-network payment amount for a given service in a given market ... HHS has been working on new regulations that purportedly will incorporate [additional] criteria.... [T]he new study calls into question whether such changes will have a substantial effect on outcomes."  MORE >>

"Health plans are expanding their platform to include home-based healthcare services, and sometimes acting as the primary care provider of record. These new services are part of the evolution to risk-based care. New technologies, including telehealth, allow for more services in the home and connections to providers in other locations."  MORE >>

12 pages. "The expiration of the ARPA enhanced premium subsidies will likely cause a decline in enrollment and a worsening of the risk pool, leading to higher premiums.... Inflation may have some effect on provider costs, but because provider payments lag inflation, real effects might not occur until later plan years."  MORE >>

"In a 7-2 decision, the U.S. Supreme Court made it harder to prove that a health plan violates the Medicare secondary payer rules when the plan requires patients to pay high out-of-pocket costs to treat kidney failure with dialysis, when patients who switch exclusively to Medicare coverage, regardless of age, could have dialysis covered at less cost to themselves." [Marietta Memorial Hospital Employee Health Benefit Plan v. Da Vita Inc., No. 20-1641 (S. Ct. Jun. 21, 2022)]  MORE >>

"Most in the healthcare industry are viewing the Court's Opinion as a victory for 340B hospitals and clinics who saw roughly $1.6 billion in annual cuts to reimbursement rates for prescription drugs after the 2018 rule went into effect. Notably, the Court recognized that 340B hospitals can make profits on the differential between their acquisition cost and the reimbursement rate for Medicare. Though the Court declined to dictate remedies, 340B hospitals may be able to recoup some of the payments that were withheld under the rule." [American Hospital Association v. Becerra, No. 20-1114 (S. Ct. Jun. 15, 2022)]   MORE >>

"The Court rejected a Sixth Circuit ruling that the MSP statute authorized liability under a disparate-impact theory." [American Hospital Association v. Becerra, No. 20-1114 (S. Ct. Jun. 15, 2022)]  MORE >>

Benefits-related items from EBSA and from the Wage and Hour Division (WHD) (changes from the Fall 2021 DOL Regulatory Agenda are noted):

Prerule Stage

• Improved Fee Disclosure for Welfare Plans
• Improving Participant Engagement and Effectiveness of ERISA Retirement Plan Disclosures
• Pooled Employer Plans

Proposed Rules

• Improvement of the Form 5500 Series and Implementing Related Regulations Under ERISA
• Definition of the Term 'Fiduciary'
• Prohibited Transaction Exemption Procedures
• Provider Nondiscrimination Requirements for Group Health Plans and Health Insurance Issuers in the Group and Individual Markets
• Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021
• Short-Term Limited Duration Insurance; Update
• Coverage of Certain Preventive Services Under the [ACA] (New)
• Requirements Related to Advanced Explanation of Benefits and Other Provisions Under the Consolidated Appropriations Act, 2021 (New)

Final Rules

• Pension Benefit Statements -- Lifetime Income Illustrations
• Adoption of Amended and Restated Voluntary Fiduciary Correction Program
• Implement SECURE Act and Related Revisions to Employee Benefit Plan Annual Reporting on the Form 5500 (moved from Proposed to Final)
• Requirements Related to Surprise Billing, Part 1
• Requirements Related to Surprise Billing, Part 2
• Prudence and Loyalty in Selecting Plan Investments and Exercising Shareholder Rights (moved from Proposed to Final)
• Amendment of Abandoned Plan Program
• Updating the Davis-Bacon and Related Acts Regulations (moved from Proposed to Final)

MORE >>

Partial list of benefit-related provisions (changes from the Fall 2021 IRS Regulatory Agenda are noted):

Proposed Rules

• Reporting and Notice Requirements for Deferred Vested Benefits Under Section 6057
• Nondiscrimination Relief for Closed Defined Benefit Plans (moved from Final to Proposed)
• SECURE Act Modifications to Certain Rules Governing 401(k) Plans
• Provider Nondiscrimination Requirements for Group Health Plans and Health Insurance Issuers in the Group and Individual Markets
• Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021
• Requirements in Connection With Coverage of Certain Preventive Services (New)
• Requirements Related to Advanced Explanation of Benefits and Other Provisions Under the Consolidated Appropriations Act, 2021 (New)

Final Rules

• Update to Minimum Present Value Requirements for Defined Benefit Plan Distributions
• Application of Normal Retirement Age Regulations to Governmental Plans
• Additional Rules Regarding Information Reporting of Minimum Essential Coverage (New)
• Withholding on Certain Retirement Plan Distributions Under Section 3405(a) and (b)
• MEPs and the Unified Plan Rule (moved from Proposed to Final)
• Application of the Employer Shared Responsibility & Certain Nondiscrimination Rules to HRAs and Other Account-Based Group Health Plans Integrated With Individual Health Insurance Coverage or Medicare (New)
• Guidance on 401(a)(9) Required Minimum Distributions (moved from Proposed to Final)
• Requirements Related to Surprise Billing, Part 1
• Requirements Related to Surprise Billing, Part 2 (moved from Proposed to Final)
• Requirements Related to Surprise Billing, Part 3 (Temporary Regulations)
• Requirements Related to Surprise Billing, Part 4 (Temporary Regulations)
• Information Reporting of Health Insurance Coverage and Other Issues Under Sections 6055 and 6056 (moved from Proposed to Final)

   MORE >>

"[T]he DOL has issued proposed regulations that represent the most comprehensive changes to the DBA since 1982.... The proposed regulations would require contractors to annualize ... all fringe benefit contributions, including for 'defined contribution pension plans (DCPPs)' to determine the hourly equivalent for which they can take a credit against the fringe benefit obligation.... For both funded and unfunded [fringe benefit] plans, the proposed regulations would also require an employer to pay any amount that an employee has been underpaid (including earnings) to an employee. In addition, employers would need to notify employees of the fringe benefits being paid and would need to ensure that the plans are properly funded."  MORE >>