577 pages. "This final rule includes payment parameters and provisions related to the HHS- operated risk adjustment and risk adjustment data validation programs, as well as 2024 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also has requirements related to updating standardized plan options and reducing plan choice overload; the automatic re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers (ECPs) and network adequacy; failure to file and reconcile; special enrollment periods (SEPs); the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers."  MORE >>

"HJRes 7 did not end the Stafford Act national emergency determination -- FEMA gets to decide when that will end, and FEMA indicates the COVID-19 national emergency is still ongoing and will end on May 11, 2023. [HHS, DOL] and Treasury seem to concur relative to the Outbreak Period rules and may be issuing clarifying guidance soon.... [U]sing July 10, 2023, as the end of the Outbreak Period, here is a cheat sheet to use regarding applicable health plan dates."  MORE >>

"To ensure compliance with the Gag Clause Prohibition, plans must annually submit an attestation of compliance with the law to the Departments. The Departments have now launched a website for submitting attestations and issued instructions, a system user manual, and a Reporting Entity Excel Template for plans and issuers to submit the required Compliance Attestation."  MORE >>

"Although HIPAA still applied during the PHE, OCR allowed compliance with HIPAA to be relaxed in certain contexts to facilitate the delivery of patient care. The OCR's four Notifications provided for enforcement discretion for telehealth services, community-based testing sites, uses and disclosures by business associates, and online scheduling of individual appointments for COVID-19 vaccinations."  MORE >>

"[T]his final rule advances proposals to prohibit Marketplace plans without a provider network, limit the profusion of non-standardized plans, encourage enrollment in plans with reduced cost-sharing for lower-income consumers, reduce deceptive marketing practices, and lower administrative barriers to enrollment. It also finalizes modifications to risk adjustment, Advance Premium Tax Credit (APTC) policy, marketplace transitions, user fees, and other marketplace standards."  MORE >>

"in asking the administrator to ensure the denial letters accurately reflect the administrator record, the court ... is requiring the administrator to refrain from standard, stock language and draft a more personalized explanation for denying benefits.... [H]ealth plan administrators must continue to review their standard language in benefit denial letters, even when such denial letters comply with claims procedure regulations, to ensure a reviewing court will find a sufficient factual basis to uphold the determination." [Brian J. v. United Healthcare Ins. Co., No. 21-0042 (D. Utah Mar. 31, 2023)]  MORE >>

"The FAQs clarify that plans and issuers are not required to make any changes to the preventive services that they cover without cost sharing as a result of Braidwood ... Any plans or issuers considering changes to their preventive services coverage should tread carefully to ensure that they do not inadvertently violate the surviving parts of the ACA preventive services mandate and/or any applicable state laws." [Braidwood Management, Inc. v. Becerra, No. 20-0283 (N.D. Tex. Mar. 30, 2023; notice of appeal filed Mar. 31, 2023)]  MORE >>

"[Y]our employee benefits plan could account for as much as 30% of your total compensation.... [Q]uestions to get the most from employee benefit plans: [1] Has your family situation changed? ... [2] How much are you contributing to your retirement plan? ... [3] How much do you typically spend on medical expenses? ... [4] Are you protecting your future (and your family's)? ... [5] Are you leaving any benefits on the table?"  MORE >>

"Amid a red-hot job market and the Great Resignation ... employers touted a plethora of benefits offerings as they tried to sway potential workers to their organizations.... [T]he number of job postings advertising benefits ... has flattened in recent months ... The slowdown is especially prevalent in low-wage sectors[.]"  MORE >>