83 pages. "This proposed rule would adopt updated versions of the retail pharmacy standards for electronic transactions adopted under [HIPAA] ... for the following retail pharmacy transactions: [1] health care claims or equivalent encounter information; [2] eligibility for a health plan; [3] referral certification and authorization; and [4] coordination of benefits. The proposed rule would also broaden the applicability of the Medicaid pharmacy subrogation transaction to all health plans."  MORE >>

"[T]he Consolidated Appropriations Act, 2021 (CAA) permitted plan sponsors to immediately implement certain mid-year changes to their cafeteria plans during the 2020 and/or 2021 plan years without first having to adopt plan amendments. Employers that implemented such relief are required to adopt certain retroactive plan amendments by December 31, 2022."  MORE >>

"The ACA's vaccine coverage requirement does not distinguish between travel vaccines and other vaccines. Under CMS's implementing regulations, the ACA is interpreted to require coverage of those immunizations recommended by the ACIP for 'routine use.' The rules go on to clarify that 'routine use' means it is 'listed on the Immunization Schedules of the Centers for Disease Control and Prevention.' Therefore, if the CDC places a vaccine on its immunization schedules, it must be covered."  MORE >>

16 pages. "The budget reconciliation measure, enacted on August 16, 2022, extends the ARPA provision that expands eligibility for and the amount of the PTC for three years to sunset at the end of tax year 2025. The [IRS] promulgated a rule on October 13, 2022, to address family eligibility for the PTC, which would expand the number of individuals who would become eligible. This report describes current law and applicable regulations and guidance, specifically with regard to how the PTC and CSR requirements apply in 2022." [R44425 updated Nov. 7, 2022]  MORE >>

"States revised, clarified and expanded leave mandates during the third quarter of 2022, with developments in California, Colorado, Connecticut, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Oregon, Rhode Island, Washington and Washington, DC.... Regulators in Arkansas and Louisiana focused on additional pharmacy benefit manager (PBM) restrictions.... Philadelphia adopted a commuter benefit mandate."  MORE >>

"PFMLI covers nearly all employers with at least one employee working in Oregon. Employers cannot opt out of providing PFMLI, and must either participate in the OED's PFMLI program or provide benefits through a state-approved PFMLI equivalent plan.... To be exempt from the January 1, 2023, contribution start date, employers must submit either an equivalent plan application or a Declaration of Intent to Obtain an Equivalent Plan to the OED no later than November 30, 2022."  MORE >>

"[P]lans and issuers should continue to offer the USPSTF-required preventive services without cost-sharing. Plans and issuers should also be mindful that states may have incorporated PHSA section 2713 into their state insurance codes, which could also impose the same or similar preventive services requirements on health insurance issuers." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Sep. 7, 2022)]  MORE >>

"The biggest barrier to HDHP and HSA adoption is education.... By communicating the value of your benefits offering and educating your staff on how your HSA-qualified plan can benefit them long-term, you can boost engagement during open enrollment and motivate your employees to explore and take advantage of their options. Here are some actionable steps you can take."  MORE >>

"Employers continue to look for ways to support employees at home with renewed interest in family forming (+2% from 2022 to 2023) and onsite childcare services (+4%). Pet insurance ... continues to be a popular benefit with 37% of respondents saying they would offer this benefit in 2023.... 69% of respondents indicating they will be offering [telehealth services] in 2023."  MORE >>

Infographic. "Costs for Pre-Medicare retirees are projected to increase 4.8% next year.... Costs for Medicare-eligible retirees are projected to rise 2.7% next year ... 1 in 5 [employers] have ceased offering or are considering replacing a group plan to pre-Medicare eligible retirees. Among those employers that terminated a group plan, 75% are replacing it with access to and financial support for individual insurance through a private marketplace."  MORE >>

"[T]wo cases in federal district court in Utah held that lawsuit filing deadlines were unenforceable because they were not disclosed in the notice of the final claims denial.... [A]nother recent case in Georgia ... held just the opposite ... [T]he more conservative decisions are a good reminder that more information is generally better in claims denial notices.... What must be, and what should be, in your denial letters to claimants?"  MORE >>