25 pages. "(December 2022 Revisions) Updated Table 2 to include review of 2022 quarterly updates of CPT/HCPCS codes with effective dates as of October 1, 2022.... [A]nesthesiology, echocardiography, and therapeutic radiology diagnostic procedure codes ... will no longer be accepted for risk adjustment eligible diagnosis filtering.... Revised Table 3 to include FY2022 and FY2023 ICD-10 diagnosis codes and FY2022 and FY2023 MCE age and sex conditions. Updated ICD-10 code labels to reflect changes in FY2023.... Updated Tables 10a and 10b to include NDCs and HCPCS codes in the National Library of Medicine's RxNorm dataset as of October 1, 2022." [Also available: Technical Details (XLSX) and 2022 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

"Although this safe harbor has proved valuable, particularly for individuals with mental health and substance use disorders, it is not mandatory. Plan sponsors are not required to offer subsidized telehealth benefits (or even offer a telehealth option at all). The late timing of this extension may mean that employers wishing to take advantage of this safe harbor will need to communicate the change to employees and perhaps issue a summary of material modifications (SMM) to correct any previously issued 2023 benefit summaries that described a roll-back of the subsidized telehealth benefit."  MORE >>

"Presently, eleven states and the District of Columbia have enacted PFML laws that cover most private employers. In each state, funding for the PFML programs is achieved through payroll tax deductions.... PFML legislation has been passed but is still being implemented in Colorado, Delaware, Maryland and Oregon. Benefits do not become available under Delaware's PFML law until 2026 and not under Maryland's PFML law until 2025. However, the PFML programs in Colorado and Oregon will become effective in the new year, with payroll deductions commencing in each state on January 1st."  MORE >>

"The Notice addressed a number of issues including, the prevailing wage requirements, the determination of the beginning of construction for purposes of certain tax credits, and the beginning of installation for purposes of the energy efficient commercial building deduction. This Alert focuses on the apprenticeship requirements of the Notice."  MORE >>

"[A] new District Court decision ... concerning mental health benefits ... found that the insurer had an insufficient basis for denying out of network benefits to the insured because the insurer failed to directly address and refute the insured's medical basis for seeking the out of network treatment.... [T]he decision reflects a move toward a more searching analysis of the administrative record to determine whether a denial was proper, and away from allowing insurers to deny benefits based on general conclusions as to the overall body of evidence." [K.D. v. Harvard Pilgrim Healthcare, No. 20-11964 (D. Mass. Dec. 12, 2022)]  MORE >>

"In litigation under Section 1557 of the [ACA], a Washington State district court concluded that a major third-party administrator (TPA) for a self-funded health plan operated a 'health program or activity' that received federal financial assistance, and therefore was subject to Section 1557's nondiscrimination protections. As a result, the TPA violated Section 1557 in denying benefits related to gender dysphoria under a health plan's categorical exclusion." [C. P. v. Blue Cross Blue Shield of Ill., No. 20-6145 (W.D. Wash. Dec. 19, 2022)]  MORE >>

"The relatively low growth of administrative expense as a proportion of total healthcare cost inflation may be driven by several factors, including increased regulatory requirements related to mandated medical loss ratios (MLRs), increased investment in automation for claims and transactional processes, and relatively low wage inflation over the period. In addition, health plans have continued to aggressively compete in the employer and group markets as well as for state Medicaid managed care contracts, which may contribute to greater efficiency and lower administrative rates."  MORE >>

"[1] Cost-saving benefits.... [2] Re-establishing remote workforce policies.... [3] Employees are making up for lost time in healthcare.... [4] Expanding wellness and wellbeing efforts.... [5] Rethinking support for reproductive care and family planning.... [6] Forging forward with DE&I initiatives.... [7] Increase in global business travel accident programs.... [8] Financial wellness programs on the rise.... [9] Rethinking family leave benefits amid new regulations and changing expectations.... [10] Pet insurance and work from gym benefits."  MORE >>

"In 2023, the nonrefundable administrative fee due from each party involved in any payment dispute that goes to arbitration will increase from $50 to $350 ... Given the volume of potential cases facing some providers, the $300 hike could put them in a no-win situation as they consider whether to formally dispute a health plan's proposed out-of-network payment amount."  MORE >>

"Victims of severe winter storm beginning December 23, 2022, now have until April 18, 2023, to file various individual and business tax returns and make tax payments ... [I]ndividuals and households affected by severe winter storm that reside or have a business in Erie and Genessee counties qualify for tax relief."  MORE >>

"[K]ey strategies and actions public service employers can take in 2023 to be employers of choice.... [1] Communicate the full value of benefits ... [2] Customize recruitment appeals ... [3] Maintain retirement plan funding ... [4] Restructure the workforce ... [5] Take a holistic view ... [6] Prioritize data driven decision making."  MORE >>