"[The ACA] affordability threshold is decreased to 8.39% for 2024 from 9.12% for 2023 ... [which] potentially lowers the cost at which a self-only coverage option must be available under a group health plan to avoid the possibility of a penalty on the employer. It requires employers to, at the very least, do an assessment of cost sharing and may require cost design changes for the 2024 plan year."  MORE >>

"The district court agreed that the QPA methodology outlined in the regulations ... deviated from the NSA statutory requirements, and it vacated those regulations as well as two other regulations governing the claim and IDR process.... [This case] represents a significant victory for providers because it shuts the door to certain types of tactical behavior by insurers around QPA calculations, and it has led the agencies to call for a total halt of the NSA IDR process while they come up with a plan to comply with TMA III pending appeal." [Texas Medical Association v. HHS, No. 22-560 (E.D. Tex. Aug. 24, 2023)]  MORE >>

"In response to this decision, all federal IDR process operations have -- again -- been temporarily suspended. The agencies indicate that disputing parties should continue to engage in open negotiation. This litigation seems unlikely to be resolved any time soon, and the latest suspension of the IDR process will surely exacerbate existing backlogs." [Texas Medical Association v. HHS, No. 22-560 (E.D. Tex. Aug. 24, 2023)]  MORE >>

"This article provides a general overview of open enrollment and changes employers should communicate to employees during the open enrollment period.... Employers can use open enrollment as an opportunity to increase communication and trust with employees by educating them on the process and their benefits choices."  MORE >>

"Organizations using reference-based pricing work with third-party administrators (TPAs) and repricers to set their own prices for healthcare services. By slashing the delivery system and insurance carrier margins, organizations can lower their total cost of healthcare."  MORE >>

"With adults in the Midwest and South having higher obesity rates, states’ coverage programs and regional employers could face higher health insurance costs – particularly in the short term – and seek ways to control the use of newer weight-loss drugs. As coverage of GLP-1 prescription drugs develops, regional trends could diverge."  MORE >>

"A robust benefits package is no longer optional for businesses hoping to retain valued employees.... Listen, set a budget, and flex your mindset.... [1] Ask employees what they're missing.... [2] Know how benefits motivate your employees.... [3] Don't overestimate the cost of benefits.... [4] Add access as an employee benefit."  MORE >>

"While the actual impact of these changes on key participants (Part D plans, pharmaceutical manufacturers, Medicare beneficiaries, and the federal government) will play out over time, we can evaluate potential behavior changes for the key participants and their financial impact now, in anticipation of those future changes."  MORE >>

"The pharmaceutical and life sciences industry has quickly transformed in the past few years with new roles on the rise, changes in organizational structures and deepening talent deficits in areas that have been understaffed for some time. Additionally, M&A activity -- which is expected to increase -- is ramping up the competition for talent ... [This article discusses] some of the strategies and areas of focus that organizations need to explore and develop to compete for talent and achieve business goals."  MORE >>

"[T]he court of appeals ... [explained that] the choice between a remand or an award of benefits 'depends on the specific flaws in the plan administrator's decision.' Unless the evidence in the record 'clearly shows' an entitlement to benefits, the Tenth Circuit maintained that a remand was more appropriate, finding the defendant's 'fail[ure] to consider all of the evidence before it, fail[ure] to explain adequately why it denied Plaintiffs' claims, and fail[ure] to engage adequately with Plaintiffs' was not enough to justify an outright award of benefits. What is missing from the Tenth Circuit's opinion is any citation supporting the court's authority to remand the matter." [P. v. United Healthcare Ins. Co., No. 21-4129 (10th Cir. Aug. 15, 2023)]  MORE >>

"Taxpayers affected by the storm that began on Aug. 27. 2023, now have until Feb. 15, 2024, to file various individual and business tax returns and make tax payments.... [I]ndividuals and households affected by Idalia that reside or have a business in Alachua, Baker, Bay, Bradford, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, Sumter, Suwannee, Taylor, Union, Volusia and Wakulla counties in Florida qualify for tax relief."  MORE >>