"The method of attesting compliance with the gag clause prohibition is somewhat similar to the RxDC reporting under section 204 of the CAA. However, the information required for this attestation is much less involved. Plans who have not already done so should determine if each of their service provider agreements comply with this requirement."  MORE >>

"A Federal 'floor' for the health insurance marketplaces ... Selecting and updating essential health benefits ... Improving consumers' enrollment experience ... [A]dditional provisions [include] establishing user fee rates, updating public notice requirements for Section 1332 waivers, requiring states to start paying for a federal data service, ... updating payment parameters, and aligning payment and collections processes with federal independent dispute resolution rules under the No Surprises Act."  MORE >>

"HHS proposes to continue existing risk adjustment policies for the 2025 benefit year, with some exceptions."  MORE >>

"Act No. 129-2023 increases maternity leave to 16 weeks: 4 weeks for prenatal leave, 8 weeks after birth and 4 additional weeks for childcare. A pregnant employee may choose to use only one week of prenatal leave and use the remaining weeks after giving birth."  MORE >>

"The Ordinance applies to Illinois employers with at least one employee and covers all employees who perform at least two hours of work in any particular two-week period while physically present in the geographic boundaries of Chicago. Depending on employer size, paid leave may need to be paid out upon an employee's separation. The Ordinance becomes effective on December 31, 2023."  MORE >>

"The lawsuit alleges that UMR denied thousands of claims based on diagnosis codes and allegedly failed to comply with the requirements of the [ACA], and the DOL's claims procedures regulation.... [T]he DOL has requested a nationwide injunction against UMR with respect to allegedly improperly denied claims." [Su v. UMR, No. 23-0513 (W.D. Wis. complaint filed Jul. 31, 2023)]  MORE >>

"Blue Shield of California announced in August that it was making a significant shift in how it administers pharmacy benefits for its 4.8 million members ... Blue Shield said the new approach could save the company up to $500 million annually ... or slightly more than $100 per member per year.... But whether the new Blue Shield model is the first of a wave of new PBM alignments that HR executives could and should keep track of for their own benefits design, or merely an approach with limited applicability, is still up for discussion."  MORE >>

"[The authors] developed a taxonomy of possible payment mechanisms for gene therapies ... [and] illustrate how these payment models take three main approaches: amortization ... risk spreading ... and performance-based payment ... [They] discuss each payment model, its advantages and challenges, and considerations for U.S. payers."  MORE >>

"Precision medicine tests and therapies are being adopted into clinical practice as evidence of their effectiveness grows. However, most private health insurers do not offer coverage for genetic or genomic services unless certain clinical criteria and evidentiary standards are met.... This article will explore the types of clinical genomic tests available today, their potential benefits, key challenges to adoption, compliance considerations, and pros and cons for employers and plan sponsors."  MORE >>

"[T]he authors discuss some of the Biden administration's recently issued cybersecurity rules and proposals and provide additional details about the Office of the National Cyber Director's [August 2023] request for information seeking comment on how to harmonize cybersecurity regulations.... The continued onslaught of new cybersecurity proposals and expectations create complex compliance burdens on organizations across a range of sectors, many of whom are already subject to various other cyber incident reporting and regulatory obligations."  MORE >>