"[E]mployers should develop and document a compliance program using what is available to show a good faith effort to comply with the MHPAEA ... Any such compliance program should include these steps: [1] Determine which vendors to contact ... [2] Develop a list of specific questions for the insurer/TPA and other vendors ... [3] Document all communications ... [4] Analyze the data provided by the insurer/TPA and other vendors ... [5] If needed, identify areas of concern and pursue corrective action ... [6] If needed, update administrative services agreements."  MORE >>

17 pages. "This advisory contains background regarding MHPAEA; a detailed analysis of the Proposed Rule, the [Technical Release], and the Report to Congress; and Practice Pointers ... Although the statement of purpose for the Proposed Rule may appear broad and generic, it evidences the departments' intent to take a holistic approach to enforcement to make sure that there is actual parity in operation -- requiring a plan to establish that it provides participants and beneficiaries appropriate access to MH/SUD benefits."  MORE >>

"The 2024 rate marks another notable decrease (down from 9.12% for 2023) and is the lowest affordability threshold since the inception of the ACA.... Applicable Large Employers (ALEs) may need to lower employee contributions towards medical coverage to meet the affordability requirement and avoid potential penalties in 2024."  MORE >>

" An employer must provide the HCE for a covered employee when the employer's office or worksite is in San Francisco or the employee works from home in San Francisco as a telecommuter.... A covered employer may comply with the HCSO by providing uniform health coverage to some or all covered employees."  MORE >>

"The court's opinion distinguished the case from Rutledge v. Pharmaceutical Care Management Association (PCMA), in which the Supreme Court held that an Arkansas law requiring PBMs to tie their reimbursement rates to pharmacies' costs was not preempted by ERISA because it did not dictate plan choices. The 10th Circuit reasoned that, whereas the Arkansas law at issue in Rutledge merely resulted in an increase of costs for the PBM, the Act goes further by potentially having a direct effect on a plan's network design, and therefore 'governs a central matter of plan administration.' " [PCMA v. Mulready, No. 19-0977 (10th Cir. Aug. 15, 2023)]  MORE >>

"For a second time this month, a Texas district court has vacated portions of tri-agency regulations that implemented the federal independent dispute resolution (IDR) process under the No Surprises Act ... Among other topics, the vacated regulations and related guidance involve rules for calculating qualifying payment amounts (QPAs) under the NSA's federal IDR process, as implemented." [Texas Medical Association v. HHS, No. 22-560 (E.D. Tex. Aug. 24, 2023)]  MORE >>

"The court found that the plaintiffs were required to show that all of the members of the class were prejudiced by UBH's use of its guidelines in their particular circumstances, but had not met that burden.... The Ninth Circuit therefore reversed the court's certification order.... [T]he most ominous part of the court's ruling came in the order accompanying the opinion, in which the court expressly stated, 'Subsequent petitions for rehearing or rehearing en banc, if any, are permissible.' In other words, this appeal is likely not over yet." [Wit v. United Behavioral Health, Nos. 20-17363 and 21-15193 (9th Cir. Aug. 22, 2023)]   MORE >>

"The August 2023 opinion states that the court had never remanded an ERISA case for reprocessing unless the claimant had shown both that the plan had applied an incorrect standard and that the claimant could be entitled to benefits under the correct standard. However, the Wit plaintiffs' claim was purely about the 'process' and not about the result.... As to plaintiffs' contention that reprocessing was a permissible remedy under the 'catchall' equitable provision of Section 1132(a)(3), the court held again that plaintiffs failed to show that reprocessing was the type of equitable remedy traditionally available before the merger of law and equity." [Wit v. United Behavioral Health, Nos. 20-17363 and 21-15193 (9th Cir. Aug. 22, 2023)]   MORE >>

"The long-term consequences of the new policy are unknown ... One theory is that reducing the prices drug companies can charge in Medicare will lead them to increase prices for the privately insured.... Another theory is that Medicare price negotiations will equip private health plans to drive a harder bargain.... Even though negotiated prices won't take effect until 2026, drug companies haven't wasted time turning to the courts to try to stop the new program in its tracks."  MORE >>

"The 'Inflation Reduction Act' (IRA) will raise prescription drug prices -- worsen patients' access to care, destroy new cures before they come to market, eliminate American jobs, threaten the United States' leading role in innovative research, and create potential constitutional concerns around government overreach."  MORE >>

"[V]ictims of flooding in parts of Alaska that began on May 12, 2023, now have until Oct. 31, 2023, to file various individual and business tax returns and make tax payments.... [I]ndividuals and households affected by flooding that reside or have a business in the regional educational attendance areas of Bering Strait, Copper River, Kuspuk, Lower Kuskokwim, Lower Yukon and Yukon Flats, in Alaska qualify for tax relief."  MORE >>