"Under the Consolidated Appropriations Act, 2021 (CAA), group health plans and health insurance issuers are required to annually attest that they are in compliance with the CAA's gag clause prohibition.... [The] rule essentially prohibits plans and issuers from entering into agreements with providers, TPAs, or other service providers that would restrict [1] provider-specific cost or quality information sharing with plan members or [2] claims data (including individual claims pricing) sharing with plan sponsors (and their service providers)."  MORE >>

"Employers providing paid family and medical leave to their employees may be able to claim a tax credit under Section 45S of the Internal Revenue Code. This 'In Focus' [1] provides an overview of the employer credit for paid family and medical leave; and [2] highlights potential issues to consider when evaluating the credit." [IF11141 Feb. 27, 2023]  MORE >>

"The COVID-19 pandemic undoubtedly played a significant role in the series of (allegedly) missed communications and payments underlying this litigation. But in the end, it was the employee's failure to demonstrate evidence of the alleged premium payments that proved fatal to her case.... [T]he Eighth Circuit offers a concise list of the sorts of evidence that a plaintiff could use to bolster claims that timely payment of premiums has been made." [Anglim v. Sharp Med. Staffing, LLC, No. 22-1021 (8th Cir. Feb. 24, 2023)]  MORE >>

"The main concerns are the insurance carrier or stop-loss provider refusing to cover claims for the COBRA participant and the scope of the ERISA plan precedent created by permitting a late election or payment exception."  MORE >>

"What's the difference between a hospital that's 'in network' and one that's a 'participating provider'? In this case, by contracting with Regence as an out-of-network but also participating provider, Swedish straddled the line between being in and out of network ... Setting the terms with an insurer for providing its members emergency or other care appears to allow hospitals to sidestep new surprise-billing laws[.]"  MORE >>

"Pay close attention to who has the responsibility to comply with Mental Health Parity disclosures (and other disclosure requirements) related to the CAA.... It is time to get serious (and maybe even more serious) about privacy and security.... Employers who have employees located in California in particular should be looking at these rules to ensure that their benefit plan service providers are in compliance with these requirements."  MORE >>

"Another case will soon test the balance of the ERISA preemption tight rope ... Last year, a district court decision upheld Oklahoma's Right to Pharmacy Choice Act. Once again, DOL and the Solicitor General have been asked to comment ... It will be interesting to see if the DOL continues or deviates from its recent position on ERISA preemption. In addition, state legislatures are considering bills that would further challenge ERISA preemption."  MORE >>

"[At] least 16 states have policies in place that affect access to abortion medication and the laws banning abortion in at least 13 states apply to medication abortion just as they apply to surgical abortion. To add to the confusion, ... a federal district court in Texas could soon put a halt to access to abortion medication for all women in the US, not just women in states banning or restricting abortion."  MORE >>

"[A] best estimate as of now, based on available data and projections of how the affected individuals will respond, is that the redetermination process could increase the overall enrollment in employer group health plans (and, by extension, cost) by 1%-3% over the redetermination period.... Industries that have higher Medicaid-eligible populations, such as hospitality and retail, will be the most affected."  MORE >>

"Nationwide, about 15 million people are expected to lose Medicaid coverage as a result of redeterminations. More than half will be able to transition to employer-based plans or marketplace coverage. However, a large portion (45%) may be disenrolled for administrative reasons despite still being eligible."  MORE >>

114 pages. "[The] objectives for this study were ... [1] To provide an overview of the distribution of and payment for pharmaceuticals in the medical assistance managed care program. [2] To review the reimbursement practices of pharmacy benefit managers [PBMs] to pharmacies within this Commonwealth. [3] To review the reimbursement practices of managed care organizations to [PBMs]. [4] To investigate and compare the reimbursement rates paid by [PBMs] to independent pharmacies and chain pharmacies. [5] To study the best practices and laws adopted by other states to address concerns with pharmacy reimbursement practices of [PBMs]."  MORE >>