"Plan sponsors might soon see an influx in requests for mid-year enrollment due to the loss of Medicaid coverage.... Plans should ensure their claims administrator follows plan terms and removes any time extensions applicable to claims and appeals adopted due to the [national emergency (NE)].... If the plan sponsor did take advantage of the safe harbor for employer actions, recognize that applicable notice deadlines going forward must adhere to pre-NE COBRA and ERISA rules.... Plans sponsors have the opportunity (except those with HDHPs ... ) to reevaluate whether they wish to continue offering free or low-cost COVID-19 testing."  MORE >>

"Consider whether the plan will continue to cover COVID-19 testing and/or out-of-network vaccines without cost sharing, prior authorization, or other medical management requirements.... Consider sending communications to participants and qualified beneficiaries notifying them of the end of the Emergency Declarations and the associated impact. Consider extending any imminent deadlines to minimize the impact on participants and beneficiaries."  MORE >>

"[As] of July 11, 2023, generally applicable deadlines to make COBRA elections; make initial or monthly COBRA premium payments; provide notification of Social Security disability determinations, HIPAA special enrollment or COBRA qualifying events; and file claims, appeals, and for external review will resume.... Current guidance does not impose specific notice requirements (e.g., furnishing a dedicated notice to plan participants advising of adjustments to plan deadlines)."  MORE >>

"CMS will extrapolate RADV audit findings beginning with payment year (PY) 2018 and will not extrapolate RADV audit findings for PYs 2011 through 2017.... CMS will not apply a Fee-For-Service (FFS) Adjuster in RADV audits. MA organizations will be required to remit improper payments identified during RADV audits in a manner specified by CMS.... Despite its promise of transparency and certainty, CMS [1] Did not adopt any specific sampling or extrapolation audit methodology.... [2] Shifted its RADV approach to a more targeted, risk-based approach that incorporates unspecified risk factors."  MORE >>

"The ordinance applies to any employee of a covered employer who (1) works within the geographic boundaries of San Francisco, including part-time and temporary employees; and (2) is a member of the reserve corps of the United States Armed Forces, National Guard, or other uniformed service organization of the United States."  MORE >>

"In analyzing the plaintiffs' fiduciary breach claim, the Court stated that plaintiffs could 'seek 'appropriate equitable relief' ... The Court found, however, that the plaintiffs and the district court 'did not explain or refer to precedent showing how a 'reprocessing' remedy constitutes relief that was typically available in equity.' Consequently, the Court held that the district court erred in concluding that 'reprocessing' was an available form of 'appropriate equitable relief' under ERISA." [Wit v. United Behav. Health, No. 20-17363 (9th Cir. Jan. 26, 2023)]  MORE >>

"OCR used its February 2 announcement of the Banner Health settlement to warn health plans, health care providers, health care clearing houses (covered entities) and business associates covered by HIPAA to guard their own system containing protected health information against breach by cyber hacking even as the [DOL] and other agencies are stepping up their cybersecurity rules, oversight and enforcement."  MORE >>

"HHS noted that nearly three-quarters of the breaches reported to the agency in 2021 involved hacking/IT incidents. For this reason, HHS has underscored the need for HIPAA CEs and business associates (BAs) to be vigilant in their efforts to regularly monitor system activity for hacking incidents. Here, by contrast, HHS's investigation of the health system (which took place several years ago) revealed what the agency characterized as 'long term, pervasive noncompliance with the HIPAA Security Rule.' "  MORE >>

"This paper discusses the current state of clinical understanding and research on the health implications of acute COVID-19 and Long COVID along with the responses of health and life insurers in product design, underwriting, and claims management."  MORE >>

"We need to do more to protect employers' interests, but the employer community also must take a big step forward, read the tea leaves, and once and for all, ensure some level of paid leave for their employees so that their workers can take care of themselves and their families. It's good for the people they employ, and it's good for business. Conversely, employees must understand their role in safeguarding the FMLA by using time away from work with integrity and only for the reasons intended under federal law."  MORE >>

"P4ESC would like to highlight the following principles and priorities that are important to ensuring that employment-based coverage thrives into the future. [1] Preserve and strengthen employer-sponsored health coverage. [2] Address medical costs and challenges to help keep coverage affordable. [3] Uphold the current tax-treatment of employer-sponsored coverage. [4] Provide employers with compliance relief from burdensome regulations governing health coverage. [5] Promote innovations and diversity of plan designs and offerings for employees."  MORE >>