"[T]he Departments have stressed that even if an employer contracts with third-party administrators or other service providers to administer the plan, the employer is still obligated to ensure that the plan satisfies the requirements under MHPAEA.... Employers should pay special attention to ... two new 'areas of priority' added to the list included in the ... January 2022 Report to Congress: [1] impermissible exclusions of key treatments for mental health conditions and substance use disorders, and [2] adequacy standards for MH/SUD provider networks."  MORE >>

"The proposed rules would for the first time provide employers with detail on the requirements for the 'comparative analysis' regarding nonquantitative treatment limitations that plans have to do under a 2021 statute. Outcomes data would be needed to evaluate material differences in access between MH/SUD providers and medical/surgical providers."  MORE >>

"If the proposed regulations are finalized, the Departments intend to create an enforcement safe harbor with respect to NQTLs related to network composition for plans and issuers that meet or exceed specific data-based standards. The exact standards will be identified in future guidance but are anticipated to be high standards."  MORE >>

"[HHS, DOL] and Treasury on [August 4] temporarily shut down the system for settling disputes over out-of-network payment amounts under the No Surprises Act. A day earlier, a federal judge ... ruled that a 2023 change in the administrative fee from $50 to $350 per IDR case was unlawful because HHS did not use a notice-and-comment period before enacting the increase." [Texas Medical Association (TMA) v. HHS, No. 23-0059 (E.D. Tex. Aug. 3, 2023)]  MORE >>

"A lengthy delay in the Departments' correction of their rules could spell headaches for both payers and providers.... Many stop-loss policies and other funding arrangements limit or exclude coverage for plan claims not paid with the policy period or, if the policy includes run off coverage, that brief period following the policy year end. Delays in payment also could complicate year end underwriting for renewals." [Texas Medical Association (TMA) v. HHS, No. 23-0059 (E.D. Tex. Aug. 3, 2023)]   MORE >>

"This ruling will likely have a significant impact on lawsuits brought by out-of-network health care providers seeking to recover additional monies directly from payors and claims administrators based on allegations that an oral or implied contract was formed during verification of benefits and/or authorization calls, or to assert other quasi-contract or equitable grounds for recovery against a health plan or insurer." [Aton Center, Inc. v. United Healthcare Ins. Co., No. D080122 (Cal. Ct. App. July 27, 2023)]  MORE >>

"Plaintiff asserted that the fiduciary exception to the attorney-client privilege applies to Unum's communications throughout the claim. Unum argued that the fiduciary exception did not apply because the liability 'exception to the exception' preserved the privilege.... [T]he Court found that Unum failed to establish that an adversarial relationship developed with Plaintiff before the dates of the communications listed on the privilege log." [Hardy v. Unum Life Insurance Company of America, No. 23-563 (D. Minn. July 28, 2023)]  MORE >>