19 pages. "CMS is issuing this RFI to gather input from the public regarding a variety of topics related to the coverage of benefits in health plans subject to the [essential health benefits (EHB)] requirements of the ACA. These topics include: [1] the description of the EHB, [2] the scope of benefits covered in typical employer plans, [3] the review of EHB, coverage of prescription drugs, and [4] substitution of EHB."  MORE >>

"The first RxDC report is due by Dec. 27, 2022, and covers data for the 2020 and 2021 reference years. Going forward, the annual deadline is June 1 of the calendar year immediately following the reference year. This means that the second RxDC report is due by June 1, 2023, and will cover data for 2022."  MORE >>

"Although the departments acknowledge that the required information resides primarily with plan vendors, the guidance does not meaningfully shift reporting responsibility to vendors -- at least for self-funded plans. Employers must ensure all information is reported and are liable for all reporting failures, even for vendor-reported data to which employers have no access."  MORE >>

34 presentation slides. Topics include: [1] Washington update; [2] Consolidated Appropriations Act of 2021 (CAA): prescription drug reporting, surprise billing, MHPAEA analysis on Non-Quantitative Treatment Limitations (NQTLs), miscellaneous CAA items; [3] Transparency in coverage reporting; [4] Dobbs v. Jackson Women"s Health Organization and medical travel benefits; [5] Recap of coronavirus impact on employer H&W benefits; [6] Proposed 1557 regulations; and [7] COLA updates.  MORE >>

"Applicable large employer (ALE) status is determined year-by-year on a calendar year basis. All ALEs are subject to Section 4980H offer of coverage requirements and Section 6056 employer reporting requirements on Form 1094-C and Form 1095-Cs. ALEs may count hours of service using one of two measurement methods, the monthly measurement method or the look-back measurement method. ALEs must provide minimum essential coverage to employees that is affordable and offers minimum value to avoid penalties under the [ACA]."  MORE >>

"[T]he Supreme Court declined to review whether federal law preempts a Seattle Ordinance mandating that large hotels offer their employees health insurance coverage or increased pay. This left the Ninth Circuit's ruling, which found that the particular ordinance was not preempted, as the last word on the issue (at least for now)." [ERISA Industry Committee (ERIC) v. City of Seattle, No. 20-35472 (9th Cir. Mar. 17, 2021; unpub.; cert. pet. denied Nov. 21, 2022)]  MORE >>

"[T]he Ninth Circuit confirmed that a district court must decide whether the plan administrator's decision to deny LTD benefits is supported by the record and cannot engage in a new determination of whether the claimant is disabled." [Collier v. Lincoln Life Assurance Company of Boston, No. 21-55465 (9th Cir. Nov. 21, 2022)]  MORE >>

"The [IRS] increased plan contribution rates for spending accounts and minimum deductibles high deductible health plans (HDHPs). Two Supreme Court decisions in 2022 may impact employer group health plan designs moving forward. Gender discrimination continues to be an important topic."  MORE >>

"On November 16, the U.S. Senate passed Medical Marijuana and Cannabidiol Research Act [HR 8454], which was passed by the House of Representatives in July. News reports have predicted that Biden will sign the bill. The bill doesn't specifically address health plan coverage of medical marijuana, but the processes it sets in motion could lead to greater clarity on the issue."  MORE >>