91 pages. "This initial guidance describes how CMS intends to implement the Negotiation Program for initial price applicability year 2026, and specifies the requirements that will be applicable to manufacturers of Medicare Part D drugs that are selected for negotiation and the procedures that may be applicable to manufacturers of Medicare Part D drugs, Medicare Part D plans, and providers and suppliers (including retail pharmacies) that furnish Medicare Part D drugs." [Also available: Fact Sheet]  MORE >>

"Due to the ongoing requirements of the ACA, there will be minimal actions that employers need to take after the PHE ends regarding vaccine coverage. The primary changes are that ACIP-recommended COVID-19 vaccines should be covered immediately instead of after a 15-day hold period and that health plans can decide whether to apply cost sharing, prior authorization and medical management requirements to COVID-19 vaccines obtained from an out-of-network provider."  MORE >>

"[E]mployees are entitled to start using their paid leave 90 days following the commencement of their employment or 31 March 2024, whichever is later. The employee may use the paid leave for any purpose without fear of retaliation; the employee does not need to provide a reason to the employer, nor does the employee need to provide documentation or support for the paid leave."  MORE >>

"This decision highlights the importance of providing claims procedures that are consistent with ERISA's requirements. As the appellate and trial courts noted, the plan document is at the center of ERISA. While it is generally acceptable and convenient to set forth a plan's claims procedures in a document that is separate from the formal plan document, it is crucial to expressly incorporate these procedures by reference -- otherwise they are not actually part of the plan." [Yates v. Symetra Life Insurance Company, No. 22-1093 (8th Cir. Feb. 23, 2023)]  MORE >>

"[T]he Fourth Circuit endorsed seeking judgment, not via summary judgment or a quasi-summary judgment procedure, but through Federal Rule of Civil Procedure 52 if the case involves de novo review of a benefit claim with factual disputes. Rule 52 allows a court to conduct a 'trial on the papers' and thus issue findings of fact and conclusions of law." [Tekmen v. Reliance Standard Life Ins. Co., No. 20-1510 (4th Cir. Dec. 16, 2022)]  MORE >>

"On March 1, 2023, the House Committee on Oversight and Accountability launched an investigation into PBM practices.... Last year, the Federal Trade Commission (FTC) launched an investigation into the PBM industry, seeking information on the competitive impact of the contracting and business practices of the six largest PBMs.... Additionally, the OIG announced its intent to issue a report on whether States provide adequate oversight of Medicaid MCOs to ensure accountability over amounts paid for prescription drug benefits to PBMs."  MORE >>

"The reports include important data from the HIPAA complaints investigated, highlight areas of noncompliance, and provide insights into trends such as cybersecurity readiness.... Regulated entities should be mindful that OCR opens compliance reviews to investigate all reported breaches affecting 500 or more individuals and may open compliance reviews into reported breaches affecting fewer than 500 individuals."  MORE >>