"Two reports illustrate the departments' significant MHPAEA enforcement activities and efforts to work with employers, carriers and third-party administrators (TPAs) to correct potential compliance failures, while providing specific examples of non-compliance and corrections. The accompanying proposed rules, if finalized, provide a roadmap for future enforcement activities and would add strict new guidelines related to network adequacy, but potentially offer some relief in the form of 'exceptions' for group health plans and insurers."  MORE >>

"On July 25, 2023, [DOL, Treasury and HHS] issued a proposed rule on how to comply with the nonquantitative treatment limitations (NQTL) comparative analyses requirements ... [T]he DOL has been aggressively enforcing the requirement through extensive, multi-year health plan investigations ... [which] are not limited to a health plan alone and routinely require plan vendors (TPAs and insurers) to provide information and/or reprocess claims. In some instances, lengthy investigations resulted in prospective changes to plan terms, as well as reprocessing claims -- including going back multiple years."  MORE >>

"Self-insured plan sponsors can calculate the average number of covered lives using either ... [1] [C]ount the actual covered lives on each day of the plan year and divide by the number of days in the plan year.... [2] Choose one or more days during each calendar quarter, add the covered lives on those dates and divide by the number of dates used.... [3] Sponsors who offer only individual coverage take the number of participants reported [on Form 5500] at the beginning of the plan year, plus the number reported at the end of the plan year and divide by two."  MORE >>

"Louisiana's Act No. 210 provides unpaid leave for employees to receive genetic testing and preventive cancer screening. To qualify for leave, employees must provide adequate notice and schedule the leave at a time that will not unduly burden the employer. The new law takes effect on August 1, 2023."  MORE >>

"Maine and Minnesota followed a familiar template: lengthy on-ramp before the program begins, standard qualifying reasons, expansive family member definition and a private plan option. A notable deviation is Minnesota's simultaneous start date for contributions and benefits, largely due to initial funding of more than $650 million."  MORE >>

"[F]or plan years ending after December 31, 2024, a high-deductible health plan will no longer be permitted to provide coverage for COVID-19 testing and treatment under the HDHP before the minimum HDHP deductible is met without jeopardizing a participant's HSA eligibility.... Notice 2023-37 ... clarified that the preventive care safe harbor does not include screening (i.e., testing) for COVID-19, effective as of June 23, 2023 ... [T]his clarification will not be relevant for HDHPs/HSAs until the first plan year ending after December 31, 2024."  MORE >>

"The Court noted that plan provisions gave discretionary authority to the employer's 'Benefit Committee.' However, it observed that a separate entity called the 'Benefits Department' made the claims determination.... The Court ruled that 'when the benefits decision is made by a body other than the one authorized by the procedures set forth in a benefits plan, federal courts review the benefits decision de novo.' " [Laake v. Benefits Committee, Western & Southern Financial Group Co., No. 21-4178 (6th Cir. May 19, 2023)]  MORE >>

"the court found that the evidence supported the district court's finding that the Company's firing of Plaintiff was motivated by Plaintiff's past and anticipated future use of ERISA health benefits. The Company's healthcare invoices had Plaintiff's hip replacement surgery costs highlighted, and though anonymized, it was not difficult for someone in the Company to identify Plaintiff and his expenses." [Kairys v. S. Pines Trucking, Inc., No. 22-1783 (3d Cir. July 25, 2023)]  MORE >>

"The Ways and Means Committee approved the Health Care Price Transparency Act of 2023 (HR 4822; section-by-section) ... Hospitals, ambulatory surgical centers, imaging providers, and clinical labs [would] be required to publish the actual price for their services, giving patients confidence they are receiving the care they need at a price they can afford and giving providers an incentive to lower prices through competition.... The Committee also approved the Providers and Payers COMPETE Act (HR 3284) which requires [HHS] to examine how Medicare payment rules may affect health care consolidation."  MORE >>

"Employer-sponsored health plans are investigating the possibility of organizing risk pools to help finance the high cost of prescription drugs.... Employers are particularly worried about high-cost drugs that can run more than $1 million. Even with stop-loss insurance, which covers high claims costs, employers can end up footing the bill after a drug is covered the first year. High-cost specialty drugs now make up more than 53% of drug spending[.]"  MORE >>

"The power to negotiate prices directly with drug companies is one Medicare has never before had in its 58-year history. Exercising that power requires the government to grapple with a difficult question: What makes a drug price fair? Whatever approach the agency takes to answering that question could have major ripple effects on both the affordability and availability of prescription drugs -- now and for decades to come."  MORE >>

"IRS Notice 2019-45 appears to have had a negligible impact on overall cost sharing as a percentage of total spending on a number of services impacted by the notice.... Enrollment in HSA-eligible health plans among individuals with health conditions impacted by the IRS notice does not appear to have changed, as it was already trending in the direction of higher enrollment among individuals with health conditions prior to the issue of the notice."  MORE >>