"The Final Rule addresses specific disclosure requirements for group health plans and health insurance issuers related to the Qualified Payment Amount (QPA) for out-of-network (OON) services and sets forth the factors and information which certified Federal Independent Dispute Resolution (IDR) entities must consider in arbitrating disputes for OON services or items. The Final Rule is effective October 25, 2022, for services/items rendered during plan years beginning or after January, 1, 2022."  MORE >>

"Employees and dependents covered by the specialty HRA must also be enrolled in an employer-sponsored group major medical plan through either the employer offering the HRA or through another employer, such as the spouse's medical plan."  MORE >>

"Given the changes to employee demographics as a result of the pandemic, it's increasingly likely that employees who worked in San Francisco are now working somewhere else or that employees who live, but did not work, in San Francisco are now working from home. As a result of these changing dynamics, the employer may be subject to the HCSO's new health care expenditure requirements."  MORE >>

"Most employee benefit plans that provide tax-advantaged benefits include nondiscrimination rules to discourage employers from providing more generous benefits to highly compensated and/or key employees.... [1] Self-Insured health plans.... Eligibility test ... Benefits test ... Possible remedies ... [2] Fully insured health plans.... Eligibility test ... Contributions & benefits test ... Key concentration test ... Possible remedies ... [3] Dependent Care Assistance / FSA Plans ... Possible remedies."  MORE >>

"In 2021, the overall percentage of workers employed by private-sector employers who were eligible for health benefits was unchanged.... Since 2013, the percentage of employers with 1,000 or more employees offering health benefits to workers has been consistently near or above 99 percent.... For the smallest employers studied, those with fewer than 10 employees, the offer rate declined from 28 percent in 2013 to 22.3 percent in 2021 but increased to 24.6 percent in 2021."  MORE >>

41 pages. "The focus of this white paper is to help employers recognize and navigate the complex issues of how best to support employees living with mental health conditions and suicidal intensity and to understand the policy and legal precedent surrounding best practices for prevention, intervention, crisis response, and postvention.... [P]roactive investment in mental health promotion and suicide prevention is not only the right thing to do, but also the strategy that will result in a positive ROI for the organization and will help mitigate risk for the company."  MORE >>

"Should the decision be affirmed on appeal to the Fifth Circuit and reach the US Supreme Court, a majority of the justices could conceivably decide that, at a minimum, Section 2713 impermissibly delegates authority to the USPSTF ... The current Court is apt to restrain Congress's ability to farm out work that a majority of the justices view as the province of legislatures to the federal agencies or advisory committees. Therefore, the ACA's preventive services coverage requirement faces a near certain path to some degree of judicial curtailment." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]  MORE >>

"Liberalized telehealth rules during the pandemic resulted in an exponential growth in the use of telehealth, particularly telebehavioral health. These flexibilities have allowed employers to provide additional access to much needed behavioral health care services for employees and their families ... Amending the excepted benefit and eligibility classifications under federal law will allow telehealth to be treated like any other add-on benefit like vision or dental care and will greatly expand access to telehealth services for all employees."  MORE >>

"The legislation [S 4750] is unnecessary because a variety of federal requirements already protect ESRD patients from losing their employer-provided health care benefits.... The legislation also creates a completely unworkable parity requirement for patients with end stage renal disease (ESRD).... The bill fails to account for different medical practice standards, treatment needs, and value-based benefit designs for widely varying chronic medical conditions and incorrectly assumes or implies that, from a medical perspective, all chronic conditions are and should be treated exactly the same."  MORE >>