"The CMS notice directs certified IDR entities to continue working through other parts of the IDR process as they wait for additional direction from the agencies. Presumably this means that disputing parties will still be able to submit notices of IDR initiation through the IDR portal, further exacerbating the growing backlog of disputes."  MORE >>

"[Field Assistance Bulletin 2023-1] confirms that FLSA and FMLA requirements apply whether work is performed at a remote location or at a designated work site.... [A new opinion letter] clarifies that employee rights under the FMLA are distinct and separate from those under the Americans with Disabilities Act (ADA), and the requirements of each statute must be analyzed separately. Leave provided as a reasonable accommodation under the ADA, however, also may qualify as FMLA-protected leave."  MORE >>

"Under the proposed regulations, the reporting requirements would apply to self-insured and insured group health plans and insurers, but not to health reimbursement arrangements, excepted benefits, and short-term, limited-duration insurance.... [T]he regulations have not yet been finalized, so it is unclear at this time when the first report will be required."  MORE >>

"The disclosure requirement applies to all plan sponsors that provide prescription drug coverage to Part D-eligible individuals, even those that do not make prescription drug coverage available to retirees.... Individuals who will become Part D eligible after the start of the plan year should not be included in the count for that year. However, they must be provided a notice of creditable or non-creditable coverage prior to their initial Part D enrollment period."  MORE >>

"The maximum annual limits on cost sharing that a group health plan can impose for 2023 is $9,100 for self-only coverage and $18,200 for family coverage ($9,450 and $18,900, respectively, for 2024).... Plans are not required to include premiums, balance billing amounts for non-network providers or spending for non-covered services. While the OOPM limit only applies to EHBs, many employers apply the OOPM limit to all in-network benefits to ease plan administration."  MORE >>

"The DOL has started including these cybersecurity questions and inquiries in health and welfare plan investigations ... Plan sponsors of health and welfare plans should remember that compliance with [HIPAA] may not be enough -- and the DOL's cybersecurity guidance must also be considered."  MORE >>

"U.S. Senate Commerce Committee members on Thursday vented bipartisan confusion and frustration about the opaque, unregulated, and possibly anticompetitive practices of pharmacy benefits managers and their reputed role in driving up drug costs for consumers.... [The committee] met to discuss Pharmacy Benefit Manager Transparency Act of 2023 [S 127], a bill that would enhance state and federal oversight of PBMs."  MORE >>

"[T]he Center for Medicare & Medicaid Innovation (CMMI), the research arm of [CMS], will implement three demonstration models ... [1] generic medications used to treat common chronic conditions. [2] A Medicaid project focused on the emerging field of cell and gene therapies. [3] A Medicare Part B model that would reduce payments for medications approved via the [FDA] Accelerated Approval pathway while the sponsors generate evidence from confirmatory trials."  MORE >>

"U.S. Secretary of Labor Marty Walsh is resigning his cabinet post to become the next executive director of the NHL Players’ Association, according to the NHL and Department of Labor. The announcements confirmed reports of his departure that surfaced last week."  MORE >>