"These adjustments are effective for penalties assessed on or after October 6, 2023, for violations occurring on or after November 2, 2015.... HHS's 'annual' adjustments are supposed to made by January 15 of each year, but in practice have come at irregular intervals. The preceding adjustment was made on March 17, 2022."  MORE >>

"The standard monthly premium for Medicare Part B enrollees will be $174.70 for 2024, an increase of $9.80 from $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023.... The 2024 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in [a] table."  MORE >>

"The FAQs indicate that the government will appeal TMA III and that no additional interim guidance is planned in response to the decision. The agencies state, however, that they are working quickly to bring systems into compliance and will provide updates on the CMS website regarding changes in IDR portal availability."  MORE >>

"[T]he proposed rule would grant CMS the discretion to publish non-proprietary drug pricing information reported to it by a drug manufacturer or a PBM. Manufacturers and PBMs that fail to provide specific information or decline to provide the information requested would be referred to the [HHS] Office of the Inspector General for possible imposition of civil monetary penalties."  MORE >>

"With commercialization, the way in which vaccines are paid for and whether they are covered by insurance will now be dictated by insurance market rules and regulations. Because of the [ACA] and laws passed during the COVID-19 pandemic, COVID-19 vaccines will continue to be free of charge to virtually everyone with private and public insurance coverage ... This cheat sheet provides details on coverage rules by insurance type and for people who are uninsured."  MORE >>

"For health and welfare plans subject to ERISA, there is no requirement that SPDs be routinely provided every year. In general, health and welfare plan SPDs must be furnished when a participant first becomes covered by a plan and at specific intervals thereafter. Different deadlines apply in different situations[.]"  MORE >>

"Employers within the scope of the Act include those with 50 or more full-time employees who work within the specified geographic area and at an address that is located within one mile of a fixed-route transit service.... [C]overed employees are those who perform an average of at least 35 hours of work per week for compensation on a full-time basis."  MORE >>

"The new rules ... are set to become effective on October 15, 2023. They provide clarity on various ESSTA topics such as calculating employer size, employee eligibility, documentation standards, notice requirements, and accrual methods."  MORE >>

"Utilization of ambulance services remained relatively unchanged between 2012 and 2021 ... The average price of a ground ambulance trip increased 33% from $820 in 2012 to $1,093 in 2021. The average out-of-pocket cost for a ground ambulance trip increased 64% from $140 in 2012 to $229 in 2021 ... 35% of ground ambulance trips were out-of-network in 2021, down from 43% out-of-network in 2012. Most of the decline occurred between 2020 and 2021 ."  MORE >>

"[These[ comments will focus on the emphasis placed on outcomes in determining adherence to MHPAEA; the proposals for improving assessment of compliance and enforcement of Non-Quantitative Treatment Limitation (NQTL) provisions and the burden on payers of the processes outlined for improving oversight and enforcement of NQTL provisions; the provisions granting exceptions to the NQTL assessments; and the standard and measures used to evaluate network adequacy."  MORE >>