"With the Family Bereavement Leave Act (FBLA), Illinois has expanded upon the unpaid leave time provisions previously available in the Child Bereavement Leave Act.... [T]he Paid Leave Act ... demands that even employers located in certain municipalities or counties with enacted local ordinances yet are not subject to those local ordinances for various reasons, will by default be subject to the Paid Leave Act."  MORE >>

"[U]nder a rule specific to network composition, plans would be required to collect and evaluate additional data, including in-network and out-of-network utilization rates, time and distance data and data on providers accepting new patients to demonstrate compliance with the parity requirements. In evaluating such data, the Departments would view higher rates of network usage for M/S benefits as compared to MH/SUD benefits as a sign of noncompliance."  MORE >>

"The end of enforcement discretion under the Telehealth Notification and the recent emphasis on tracking technology comes as cyber-attacks against the healthcare industry continue to present significant threats to patient safety, hospital operations and personal health information.... While hospitals and health systems are often targeted, cyber criminals also exploit perceived security gaps in vendors and suppliers that access health information."  MORE >>

"The vacated provisions involve regulations on batching items or services for IDR payment determinations under the surprise medical billing rules and related guidance concerning application fees for the IDR process." [Texas Medical Association (TMA) v. HHS, No. 23-0059 (E.D. Tex. Aug. 3, 2023)]   MORE >>

"In recent months, plan sponsors of self-funded health plans have filed three cases against Aetna, Elevance, Inc. (formerly known as Anthem, Inc.), and Blue Cross Blue Shield of Massachusetts in their capacities as third-party administrators ('TPAs') under similar theories of liability. Plan sponsors should consider performing audits of self-insured plan benefit claims to assess whether participants are being overcharged."  MORE >>

"Among other things, the Consolidated Appropriations Act (CAA) requires group health plans to attest that they are in compliance with the CAA's gag clause prohibition.... [W]hat's an employer to do if its plan is not in compliance? And what if the TPA or PBM doesn't contractually restrict the data, but in practice restricts the data? Is it okay for a TPA or PBM to restrict information as long as they don't contractually do so?"  MORE >>

"[The authors] investigated the ratio of commercial-to-MA prices negotiated by the same insurer, in the same hospital and for the same services, using 2022 price information disclosed by hospitals in compliance with the hospital price transparency rule. Insurers negotiated median hospital prices for commercial plans that were two to three times higher than their MA prices in the same hospital for the same service. The median commercial-to-MA price ratio in the same hospital varied, from 1.8 for surgery and medicine services to 2.2 for laboratory tests and emergency department visits and 2.4 for imaging services."  MORE >>

"Notwithstanding broad agreement on reforms affecting employer plans, there are differences and jurisdictional issues in the committee-passed bills that need to be reconciled within and between the House and Senate before a final package can be sent to the president.... [A]ny final action on PBM reforms and other proposals to enhance healthcare transparency and competition may have to wait until late this year."  MORE >>

"At its core, the proposed rule focuses on ensuring that Americans do not face roadblocks and barriers to getting mental health and substance use disorder treatment that they don't face when seeking medical benefits. Consistent with this goal, the proposed rule would also require health plans and insurance companies to show their MHPAEA compliance -- not just with words -- but with data ... The proposed rule also specifically focuses on how plans construct their provider networks[.]"  MORE >>