"CAA requires plan sponsors to demonstrate that their purchased health care services are cost effective, high quality, and meet mental health parity and pharmacy benefit requirements for their members. This means employers must take steps to establish oversight procedures and processes to document efforts to comply with the CAA as fiduciaries, similar to the governance practices organizations have already established for their 401(k) and retirement plans."  MORE >>

"The Act will entitle covered employees to earn and use up to 40 hours of paid leave in each 12-month period of their employment and go into effect on January 1, 2024. Unlike the existing Cook County and Chicago ordinances that mandate paid sick leave, the Act will entitle covered employees to use paid leave for any reason at all."  MORE >>

"On February 10, 2023, [CMS instructed] Independent Dispute Resolution (IDR) entities to hold all payment determinations in out-of-network disputes until CMS issues further guidance. IDR entities were further instructed to recall any payment determinations issued after February 6, 2023. This surprise instruction comes on the heels of a February 6 win by the Texas Medical Association (TMA) against a Final Rule promulgated under the No Surprises Act (NSA) that gave preference to health plans' Qualifying Payment Amount (QPA)." [Texas Medical Association v. HHS, No. 22-372 (E.D. Tex. Feb. 6, 2023)]   MORE >>

"[T]he Departments issued a Final Rule in August 2022, which replaced the interim provisions vacated in TMA I. Under the new Final Rule, IDREs are directed to consider the QPA first, but may consider the non-QPA factors.... As with the first case, the Plaintiffs alleged that the revised arbitration provisions still improperly restricted IDREs' authority to consider the non-QPA factors. The court agreed again at the summary judgment stage and ruled that the Final Rule had once again exceeded the Departments' rulemaking authority." [Texas Medical Association v. HHS, No. 22-372 (E.D. Tex. Feb. 6, 2023)]  MORE >>

"Legal experts ... say the appellate court largely ignored the facts at hand, applying a high-level legal critique of the case rather than assessing the merits of the case. Some behavioral health advocates see the potential fallout of the appellate court as problematic, fearing that left unchanged the ruling would have wide-ranging implications for any cases brought under the [ERISA]." [Wit v. United Behav. Health, No. 20-17363 (9th Cir. Jan. 26, 2023)]   MORE >>

"Over the last decade, the [FDA] has approved five drugs to treat obesity ... These drugs are expensive, costing as much as $1,400 a month, and necessitate long-term dosing. However, the costs of obesity are enormous: Up to half of new diabetes cases in the U.S. are linked to obesity, and obesity costs the health care system nearly $173 billion annually. It raises the question of whether employer health plan sponsors should cover this new class of drugs to treat obesity."  MORE >>

"Bundled payments, capitation, and reference-based contracting can benefit patients, and their self-funded employers, by increasing price transparency, lowering cost, and improving quality."  MORE >>

"Health insurance coverage of women's reproductive services, including abortion, is fast becoming a confusing terrain that apparently not even insurers fully understand. The [ACA] requires most private health insurance plans to cover a set of essential health benefits, including reproductive health services. Likewise, several states have passed laws mandating additional coverage of reproductive healthcare."  MORE >>