"CMS, Treasury and the DOL requested in an open letter to employers, plan sponsors, and health plan issuers, that they amend their group health plans (GHPs) to temporarily allow an extension for individuals who lose Medicaid or CHIP coverage and seek to enroll in GHP coverage from March 31, 2023 through July 31, 2024 ... Employers can work with their insurance carriers on the options available for their plans ... and should obtain approval from their insurers or stop loss carriers before making any plan changes or allowing a late plan enrollment."  MORE >>

"[T]he IDR process remains in suspension pending further action by the Departments. In the meantime, however, the [No Surprises Act IDR Administrative Fee FAQs] clarify the administrative fee amount that each disputing party will be required to pay to engage in the Federal IDR process when the IDR process suspension resumes[.]" [Texas Medical Association (TMA) v. HHS, No. 23-0059 (E.D. Tex. Aug. 3, 2023)]  MORE >>

"Workers may seek accommodations such as ... part-time or modified work schedules; more frequent breaks; ... permitting the use of paid leave (whether accrued, short-term disability, or another type of employer benefit) or providing unpaid leave, including to attend healthcare-related appointments and to recover from childbirth ... [An] employee or applicant ... need not mention the PWFA; use the phrases 'reasonable accommodation,' 'known limitation,' 'qualified,' 'essential function;' use any medical terminology; or use any other specific words or phrases."  MORE >>

"Remote employees who don’t physically report to a worksite will be deemed part of the worksite where their assignments originate. If a remote employee receives assignments from a worksite that has at least 49 on-site employees, the remote employee will be eligible for FMLA leave, provided they’ve worked the requisite time periods."  MORE >>

"[The court] rejected Aetna's argument that the named plaintiffs' failure to exhaust contractually required administrative remedies precluded them from representing the class. Aetna had categorically concluded that L-ADR surgery was experimental, and thus exhausting administrative remedies was futile.... [By] refusing to even consider whether L-ADR might be appropriate in any case, Aetna effectively repudiated any contractual right it might have to require exhaustion." [Hendricks v. Aetna Life Ins. Co., No. 19-6840 (C.D. Cal. Jul. 25, 2023)]  MORE >>

"There are two ways to influence care in the U.S. healthcare system: at the point of care ... or at the point of enrollment ... Both are important in designing a healthcare strategy, with the goal to lower costs, improve quality and enhance the member experience. How an employer approaches the overall strategy is influenced by cost drivers, demographics, philosophy, and geography."  MORE >>

"Respondents said that 52% of payments determined by independent dispute resolution entities were not made at all by insurers, whereas 49% were not made in the 30-day timeframe, and 33% were made in an incorrect amount."  MORE >>

"Although government data shows that hospitals' compliance with price transparency rules has improved, updating the requirements of that law is the focus of a new proposal by the Biden administration, which aims to further standardize the required data, increase its usefulness for consumers, and boost enforcement. Even with all that, however, the goal of exact price tags in every situation is likely to remain elusive."  MORE >>

"Rather than altering core medical benefit plans, the data suggests companies are shifting toward enhancing employee-paid voluntary benefits, effectively addressing gaps in employer spend. The data for 2023 demonstrates a surge in interest for traditional supplemental health enhancements, with accident witnessing a 41% increase, critical illness experiencing a 36% increase and hospital indemnity recording a 24% increase compared to 2022."  MORE >>

"HR departments' direct involvement in benefits education is on the decline, according to a new report  ... [O]ne-on-one conversations with HR decreased to 26 percent from 28 percent in 2022. These conversations have been replaced by employers' use of online resources at 63 percent, up from 53 percent last year. The data marks a continual decline in HR benefits communication over the past couple years -- in 2020, for instance, 33 percent of employers offered one-on-one conversations with HR."  MORE >>

30 pages. "Significant deficiencies exist in the IRS's accounting for microfilm backup cartridges. Deficiencies result in the inability of the IRS to account for thousands of microfilm cartridges containing millions of sensitive business and individual tax account records. The sensitive business and individual taxpayer information stored on the unaccounted for cartridges are key information that can be used to commit tax refund fraud identity theft."  MORE >>