"If a plan incidentally collects genetic information in connection with obtaining other information about an individual, it is not a GINA violation so long as the information is not used for underwriting purposes. This incidental collection exception will not apply if it is reasonable to anticipate that health information will be received unless the collection explicitly states that genetic information should not be provided. This situation may arise with questions typically included in health risk assessments."  MORE >>

"[T]he Departments clarified that the Braidwood decision applies only to recommendations made by the USPSTF on or after March 23, 2010 and does not affect either: [1] USPSTF recommendations made prior to March 23, 2010; or [2] recommendations made by either the Health Resource and Services Administration or the Advisory Committee on Immunization Practices. The Departments also clarified that the decision does not prevent states from enacting or enforcing their own laws requiring insurers to provide coverage for USPSTF recommendations."  MORE >>

"The Tenth Circuit stopped short of addressing the impact of the amended regulatory language on health claims head on, but determined that even if the regulations 'set[] different baseline requirements' for medical and disability claims, '[t]he regulations do not relieve United of its responsibility to engage with medical opinions in health benefit claims.' ... [In a separate MHPAEA case, a district court] focused on whether the treatment at issue was 'evidence based' and whether GHC used a 'comparable' or 'more stringent' process when limiting access to speech or occupational therapy as compared to pediatric chiropractic care." [D.K. v. United Behavioral Health, No. 21-4088 (10th Cir. May 15, 2023); Midthun-Hensen v. Group Health Cooperative of South Central Wisconsin, No. 21-608 (W.D. Wisc. May 8, 2023)]  MORE >>

"Wit v. United Behavioral Health exposed the use of a managed care organization's own internal guidelines to determine what treatment is covered even when these guidelines are contrary to professionally developed standards of care. While this litigation is not necessarily based on federal parity laws, it reveals the divergence between coverage decision making and generally accepted standards of care, and has provided revealing insight into how insurers subvert federal parity laws by relying on internal guidelines that can harm their plan members."  MORE >>

"Millions of Americans in the past few years have ... [filed] a health care insurance claim that once might have been paid immediately but instead is just as quickly denied.... [C]ompanies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims ... A job title at one company was 'denial nurse.'... [The ACA] tasked [HHS] with monitoring denials both by health plans on the Obamacare marketplace and those offered through employers and insurers. It hasn't fulfilled that assignment."  MORE >>

13 pages. "After decreasing in 2020 for the first time in MMI history, healthcare costs came roaring back in 2021 and have continued to increase in 2023.... The 4.8% annual trend since 2021 is a moderation of the 13% increase in healthcare costs from 2020 to 2021 and is similar to historical MMI trends observed before the COVID-19 pandemic.... [The authors] project healthcare costs will grow by approximately 5.6% for the MMI family from 2022 to 2023."  MORE >>

"An employee assistance program (EAP) is an effective way to assist employees through mental health issues and improve their overall well-being.... Employers can add behavioral health programs as an extra benefit on top of traditional EAP. Alternatively, some behavioral health programs can include EAP as part of their offering."  MORE >>

"In 2021, spending in hospital outpatient departments averaged 76 percent higher than in physician offices (on a utilization-weighted basis). The share of patients treated in hospital outpatient departments increased from 58 percent to 63 percent."  MORE >>

"The fiscal impact report ... estimates the 12-week expansion to all county employees would cost an additional $3.8 million in salary and associated payroll taxes.... The current cost of paid parental leave is $2.1 million ... The estimates ... assume all employees take the full 12 weeks. As it stands, about 40% of employees take less than 12 weeks off."  MORE >>