34 pages. "Federal requirements on private health insurance may apply to large-group, small-group, self-insured, and/or non-group plans.... The selected requirements discussed in this report are grouped into the following categories: [1] Obtaining coverage ... [2] Keeping coverage.... [3] Health insurance premiums ... [4] Covered benefits ... [5] Enrollee cost sharing and plan payment for benefits ... [6] Health care provider interactions ... [7] Enrollee information and appeals ... [8] Federal and public reporting requirements[.]" [R45146 Mar. 9, 2023]  MORE >>

"[M]ost employers will not want to make this attestation themselves since the TPAs and ASOs will have the information on the gag clause requirements with respect to their networks.... Employers that want to take care of this themselves should consult the [CNS] instructions and user manual ... To the extent they are using a TPA or ASO, they will likely need to coordinate with that service provider and collect information from them regarding the filing."  MORE >>

"Self-insured plans may enter into written agreements with service providers to complete the attestation on their behalf, but the plan remains legally responsible for compliance.... Plans that fail to comply may face a civil penalty of up to $100 per day, adjusted annually, for each individual affected by a violation."  MORE >>

"For the calendar year 2024, the A Penalty (IRC Section 4980H(a)) is $2,970 (which represents a $90 increase from 2023) and the B Penalty (IRC Section 4980H(b)) is $4,460 (which represents a $140 increase from 2023)."  MORE >>

"On March 3, 2023, the U.S. District Court for the District of Puerto Rico issued a decision declaring Law 41-2022 null and void, effectively reinstating the prior state of many of Puerto Rico's employment statutory entitlements. The decision will impact employees' statutory benefits and rights, including vacation pay and sick leave, meal periods, holiday bonuses, and statutory severance pay." [Financial Oversight and Management Bd. for Puerto Rico v. Urrutia No. 22-0063, 17 BK 3283-LTS (D. Puerto Rico  Mar. 3, 2023)]  MORE >>

"In [the] renewed petition for rehearing, the plaintiffs said that the court should find that UBH must follow generally accepted standards for deciding medical necessity.... They noted that the federal government, multiple states and major medical associations had all weighed in on the plaintiffs' side." [Wit v. United Behav. Health, No. 20-17363 (9th Cir. petition for rehearing filed Mar. 10, 2023)]  MORE >>

55 pages. "The purpose of this paper is to help fill a gap between applied economics, where few economic models of the pharmaceutical industry so far even acknowledge that drug benefits are managed, and regulatory practice where new benefit-management regulations are now actively considered and implemented at both the federal and state levels."  MORE >>

"Senators Maggie Hassan (D-NH) and Mike Braun (R-IN) wrote to CMS asking for changes to improve the payer price transparency rule. The changes include creating a standardizing reporting template, limiting file sizes, and requiring an organizational system and standardized labeling."  MORE >>

"If you aren't a hyper-diligent health-bill-nazi, you're likely being double-billed now when your doctor's office keys in that you had a preventive exam as well as discussion, follow-up on, or evaluation of X. Where 'X' can be any ailment, bump, sore, cut, tick, twitch, stressor, or annoyance in your life.... To say that our system has been bureaucratized beyond recognition into some sort of Frankenstein monster of public-private plunder is an understatement."  MORE >>

"Rep. James Comer (R-Ky.), chairman of the House Committee on Oversight and Accountability, announced that his committee has launched an investigation into PBMs and their business practices.... Comer is asking for a lot of information about discount cards, rebates, contracts, and more.... Pharmacists and patients have known ... for a long time that PBMs evolved their business model long ago to benefit from higher prescription drug prices.... But attempts to change the pharmacy payment model will be met with intense lobbying pressure."  MORE >>