37 pages. "This final rule will specify how and when CMS must calculate and impose civil money penalties (CMPs) when group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) fail to meet their Medicare Secondary Payer (MSP) reporting obligations by failing to register and report as required by MSP reporting requirements. This final rule will also establish CMP amounts and circumstances under which CMPs will and will not be imposed."  MORE >>

"Under [FAQs Part 62], plans and insurers must continue to make QPA disclosures with their initial payments (or payment denial notices) to OON providers, facilities, and air ambulance services providers. These disclosures (which were not vacated by the August 24 ruling) must be timely made on request from a provider or facility."  MORE >>

"The IRS lowered the threshold for 'affordable' employer coverage under the [ACA] for 2024 to 8.39% of an employee's household income, down from 9.12% in 2023. Employers should evaluate the effect of the revised affordability threshold percentage on health plan contributions and may need to consider lowering employees' contributions for the 2024 plan year. Non-compliance with the affordability threshold could lead to IRS-assessed penalties."  MORE >>

"The look-back measurement method is one of two alternative approaches permitted under the ACA for Applicable Large Employers (ALEs) to determine employees' ACA full-time status. Unlike the relatively simple monthly measurement method, the look-back measurement method adopts a more complex web of measurement, administrative, and stability periods. Despite the added complexity, this look-back measurement method approach provides significant administrative advantages for ALEs with employee populations whose hours tend to fluctuate."  MORE >>

"Effective November 1, 2023, the Massachusetts Paid Family and Medical Leave (PFML) law will allow employees to supplement (i.e. 'top off') benefits received from the Commonwealth of Massachusetts with any available accrued paid leave (e.g., sick time, vacation, PTO, personal time, etc.). Employees still cannot be required to use accrued paid leave either before or while on PFML."  MORE >>

"In a short unpublished opinion, the court held that the district court did not err by dismissing Plaintiff's complaint under Rule 12(b)(6) because Plaintiff lacks derivative authority to sue under ERISA and Plaintiff failed to sufficiently plead ERISA claims." [ABC Services Group, Inc. v. Aetna Health and Life Ins. Co., No. 22-55631 (9th Cir. Oct. 6, 2023; unpub.)]  MORE >>

"The ruling may require plans to comply with the prior HHS rule that only permitted non­ grandfathered plans to exclude the value of a manufacturer's coupon from an individual's out-of-pocket maximum when there is a medically equivalent generic available and only if permitted by state law. Currently, approximately 20 states have laws that require that any payments made on a patient's behalf be applied toward the annual out-of-pocket cost-sharing requirements." [HIV and Hepatitis Policy Inst. v. HHS, No. 22-2604 (D.D.C. Sep. 29, 2023)]  MORE >>

"[W]hile 81% of human resource (HR) decision-makers feel that their employees would be interested, only 25% cover GLP-1s today.... 79% agree that GLP-1 coverage will help employees' health long term; 77% agree that GLP-1 coverage would make employees feel they get a better health insurance package."  MORE >>

"Insurers have close to seven months, perhaps longer, before they'll face consequences for not abiding by a court ruling that struck down the current QPA methodology.... [HHS FAQs Part 62, issued on Oct. 6, state that the] administration will not enforce the court decision until at least May 1. The grace period could extend to Nov. 1, 2024, at the administration's discretion."  MORE >>

"Four in 10 working insured find their OOP costs so expensive they're dipping into their savings or taking on personal debt at staggering rates. 35% have deferred seeking medical care within the past year due to concerns about their ability to cover the associated costs, while, 50% of those with high deductible health plans reported instances in just the past three months where they needed healthcare but didn't receive it due to cost. 31% of respondents said they have some form of outstanding debt from their medical expenses (money that they owed for health care services they could not afford at the time), with 46% experiencing debt if their deductible is greater than $1,000."  MORE >>

"ERISA is commonly criticized as a hindrance to health care cost containment, as courts have interpreted its preemption clause to limit states' power to impose a wide range of health insurance reforms that affect employer-sponsored coverage. The obligations ERISA imposes on plan fiduciaries, however, may prove to be an important tool in enabling employers to become better stewards of health care dollars and help drive down spending."  MORE >>