"On August 3, 2023, the U.S. District Court for the Eastern District of Texas issued an opinion and order ... [which] vacated the $350 administrative fee per party established by the Amendment to the Calendar Year 2023 Fee Guidance for the Federal Independent Dispute Resolution Process Under the No Surprises Act: Change in Administrative Fee issued on December 23, 2022. The following FAQs explain how [HHS, DOL and the Treasury Departments] will handle the administrative fee in accordance with this order. These FAQs are not announcing the reopening of the Federal IDR portal to submit new disputes. The Departments intend to reopen the portal to permit the submission of new disputes soon and will notify interested parties at that time."  MORE >>

"[S]ponsors of self-insured plans may want to: [1] Confirm that their TPA will make the necessary changes to their plan's NQTLs based on the potential heightened requirements ... [2] Confirm that their TPA will retain and evaluate the necessary data regarding NQTLs and network adequacy ... [3] Confirm that their TPA is preparing the required comparative analyses in a manner consistent with the proposed regulations. [4] Independently review any NQTL comparative analyses that have been or are prepared. [5] Negotiate contractual protection in the event the TPA's NQTL comparative analyses are determined to be deficient or the TPA's application of NQTLs is determined to be impermissible."  MORE >>

"[EBSA], has released a new model Employer CHIP Notice with information current as of July 31, 2023.... [CHIPRA] imposes an annual notice requirement on employers that maintain group health plans in states that provide premium assistance subsidies under a Medicaid plan or a Children's Health Insurance Plan (CHIP)."  MORE >>

"[G]roup health plans are required to give employees a minimum of 60 days to enroll in their group health plans upon the loss of Medicaid or Children's Health Insurance Program coverage. However, the Biden administration is now asking group health plans to extend that period, as employees might need more time to transition to employer-sponsored health insurance -- for example, if they miss state agency notices and do not realize they have lost coverage until they go to access care."  MORE >>

"Judge Leon's opinion will likely provide key support for insurers and plans in IDR disputes with air ambulance providers because the opinion buttresses the QPA as a factor for determining the appropriate out-of-network rate for services." [Association of Air Medical Services v. HHS, No. 21-3031 (D.D.C. Aug. 4, 2023)]  MORE >>

"[A recent report from the National Association of Insurance Commissioners (NAIC)] zeroes in on an oft-overlooked component of preventive services access: confusing and seemingly arbitrary plan policies and procedures for processing and paying claims.... When a preventive service is miscategorized by a plan as diagnostic instead of preventive -- whether because the plan erroneously categorized the claim or because the provider made a billing error -- the patient may get charged cost sharing for a procedure or service that is supposed to be free."  MORE >>

"[It] is our employer health insurance financing system that is driving up the costs of the underlying markets.... [T]he financing system drives the price of the product, not the other way around.... [O]ur financing system denies employee choice and therefore we do not have a true consumer market driven system. Our employer-based financing system is the root cause of health care cost inflation because it denies consumer choice that we have for almost every other product we buy in the U.S."  MORE >>

"To determine whether your company's corporate income tax extension will automatically extend the Form 5500 deadline, you must determine the regular and extended due dates for its federal tax return. Income tax return filing deadlines, and the available extension periods, differ based on the entity's corporate form and tax year.... Plans that timely file Form 5558 have a clear Form 5500 filing deadline, which may be preferable to navigating these complex timing rules."  MORE >>