275 pages. "The PWFA requires a covered entity to provide reasonable accommodations, absent undue hardship, to a qualified employee or applicant with a known limitation related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions.... [T]he Commission has identified certain topics about which it is specifically seeking comment.... The list in the proposed regulation for the definition of 'pregnancy, childbirth, or related medical conditions' includes current pregnancy, past pregnancy, potential pregnancy, lactation (including breastfeeding and pumping), use of birth control, menstruation, infertility and fertility treatments, endometriosis, miscarriage, stillbirth, or having or choosing not to have an abortion, among other conditions.... In addition to noting paid leave (whether accrued, short-term disability, or another type of employer benefit) and unpaid leave as examples of reasonable accommodations, the proposed rule states that either type of leave to recover from childbirth is an example of a potential reasonable accommodation for pregnancy, childbirth, or related medical conditions."  MORE >>

"The Proposed Rule would substantially re-write the existing MHPAEA regulations[Nonquantitative treatment limitations (NQTLs)] -- including prior authorization, concurrent review, provider reimbursement, network adequacy, and others -- would be required to meet a new three-part test. For the first time, the Proposed Rule would apply the mathematical test that currently applies to financial requirements and quantitative treatment limitations (QTLs) (the 'substantially all'/'predominant' test) to NQTLs. The Proposed Rule, if finalized, would apply on the 1st day of the 1st plan year beginning on or after January 1, 2025."  MORE >>

"Under the proposal, plans and issuers would not be permitted to impose an NQTL unless all the following requirements are met.... [1] The NQTL is no more restrictive as applied to MH/SUD benefits than to M/S benefits.... [2] The plan or issuer satisfies requirements related to the design and application of the NQTL.... [3] The plan or issuer collects, evaluates, and considers the impact of relevant data on access to MH/SUD benefits, and subsequently takes reasonable action as necessary to address any material differences in access shown in the data to ensure compliance with MHPAEA."  MORE >>

"After 2024, covering COVID-19 testing and treatment under an HDHP without participant cost-sharing, could impact a participant's Health Savings Account (HSA) eligibility. Notice 2023-37 also provides that COVID-19 testing will not be considered preventative care for purposes of HSA eligibility as of the Notice's publication date (June 23, 2023)."  MORE >>

"This column describes the COBRA rules as they apply to Mergers and Acquisitions, as well as the risks of non-compliance.... [T]he special COBRA rules that apply in an M&A transaction ... can result in liability on buyers and sellers, as well as members of their respective controlled group ... for noncompliance."  MORE >>

38 pages. "[I]n general, Medicare is the secondary payer for beneficiaries who are also covered through ... a group health plan (GHP) based on their own or their spouse's current employment ... This report examines the [Medicare Secondary Payer (MSP)] system, reporting requirements, beneficiary responsibility, payer liability issues, and issues for Congress." [RL33587 Aug. 9, 2023]  MORE >>

"On Thursday, August 3, 2023, a federal court issued a memorandum and order ... tossing the sharp fee increase to participate in the independent dispute resolution (IDR) process under the No Surprises Act (NSA) and vacating a regulation that significantly limited the ability to batch multiple items and services into a single dispute. This is the third time in approximately 18 months that aspects of the NSA's rules and regulations have been vacated as unlawful." [Texas Medical Association (TMA) v. HHS, No. 23-0059 (E.D. Tex. Aug. 3, 2023)]  MORE >>

"The agencies previously advised that they were considering improvements to speed up IDR determinations and payments, but continuing litigation and the current suspension of the IDR process seem likely to increase the growing backlog of submitted disputes." [Texas Medical Association (TMA) v. HHS, No. 23-0059 (E.D. Tex. Aug. 3, 2023)]  MORE >>

"Rejecting the administrator's request to dismiss, the court accepted as sufficient, for this stage of the litigation, the participant's allegation that the plan's coverage of subacute residential treatment at a mental health facility was analogous to the plan's coverage of medical/surgical treatment at a skilled nursing or rehabilitation facility." [T.E. v. Anthem Blue Cross and Blue Shield, No. 22-0202 (W.D. Ky. Mar. 24, 2023)]  MORE >>

"Among older adults with employer coverage: Nearly half of low-income older adults, and more than one-third of those with moderate income, said it was very or somewhat difficult to afford their premiums. Fifty-four percent of those with low income and nearly one-third with moderate income were underinsured, meaning that they had high out-of-pocket costs and/or deductibles relative to their income.... Difficulties paying medical bills and paying off medical debt loads affected 44 percent of older adults with low income and two of five of those with moderate income."  MORE >>

"The Proposed Rule ... contains significant and broad-reaching proposals ... An additional 60 days for the development of comments will help to ensure that stakeholders are able to carefully consider the ramifications of the proposals such that the final regulations can best effectuate Congress' goals in putting forth the changes enacted through the CAA without creating unnecessary burdens for providers, plans, and patients and unintentionally impacting access to medical-surgical, mental health, and substance use disorder services."  MORE >>

"Since the needs and preferences of employees vary significantly across different regions and cultures, a perfect international benefits package is actually a myth.... Crafting a locally customizable benefits plan involves tailoring employee benefits to align with local market practices, cultural norms and legal requirements. It requires a deep understanding of the specific country's labor laws, social security systems, healthcare systems and cultural expectations."  MORE >>