"County Data for Culturally and Linguistically Appropriate Services ... The 2023 CLAS Guidance sets forth an updated list of all counties (including counties in U.S. territories) for which 10 percent or more of the population is literate only in the same non-English language, based on 2016-2020 ACS data published by the United States Census Bureau.... The Departments intend to update the following documents in the future to reflect the updates in the 2023 CLAS Guidance: [1] SBC template and sample completed SBCs in English (with updated taglines in applicable non-English languages); [2] Additional translated versions of the SBC and Uniform Glossary; and [3] Model notices for internal claims and appeals and external review (with updated taglines in applicable non-English languages)....

"The No Surprises Act ... [U]until the Departments and OPM engage in notice and comment rulemaking on the circumstances under which items and services will be considered 'related to the treatment of a similar condition,' disputes eligible for initiation of the Federal IDR process on or after August 3, 2023, should be submitted in a manner that is consistent with the statutes and regulations that remain in effect after the TMA IV and TMA III vacaturs.... As a result of the TMA III order, air ambulance services for a single air ambulance transport, including an air ambulance mileage code and base rate code, may be submitted as a batched dispute, so long as all provisions of the batching regulations are satisfied[.]"  MORE >>

Nov. 2023. "Section 2715 of the PHS Act requires group health plans and health insurance issuers offering group and individual coverage to provide the summary of benefits and coverage (SBC) and uniform glossary in a culturally and linguistically appropriate manner. The regulations implementing section 2715 adopt the 10 percent threshold set forth in the section 2719 implementing regulations.... The list below includes all counties that meet or exceed the 10 percent threshold (rounded to the nearest percent) based on the 2016-2020 ACS data and is applicable for plan years (in the 2 individual market, policy years) beginning on or after January 1, 2025 and until the next version of this guidance is issued and effective."  MORE >>

"The Colorado Family and Medical Leave Insurance (FAMLI) ... will be the first such law to provide most employees with up to 12 weeks of paid leave for various family and medical reasons. FAMLI applies to a broad range of Colorado employers -- even small employers with fewer than 10 employees ... [T]he state will determine whether or not employees qualify for FAMLI, and payments from FAMLI will come from the state, not the employer."  MORE >>

"[A] district court concluded that it could not resolve -- at the summary judgment stage -- a dispute over a local governmental employer's failure to provide COBRA election notices to employees it terminated for allegedly taking and deleting 55,000 files. The employer argued that it was excused from complying with COBRA's notice requirements because the employees had engaged in gross misconduct for COBRA purposes." [Johnson v. City of Kewanee, No. 21-4051 (C.D. Ill. Nov. 21, 2023)]  MORE >>

"In recent years, BCBS plans opened medical clinics that exclusively serve their members. Premera Blue Cross partnered with Seattle-based Kinwell Medical Group in 2022 to open primary care clinics for its members in Washington state. Back in 2016, Florida Blue and Alignment Healthcare opened six clinics for their members in Florida. This year, BCBS Arizona launched a new primary care company, Prosano Health Solutions.... In October, BCBS North Carolina announced it intends to purchase 55 North Carolina locations of FastMed, a national chain of urgent care clinics."  MORE >>

"The State Employee Benefits Committee (SEBC) reports there is currently a $15 million deficit in state health insurance funding for this fiscal year. Delaware spends an average of $1.2 billion on the Group Health Insurance Plan (GHIP) to provide healthcare to active state employees, their spouses and dependents, retirees pre-Medicare and state pensioners.... At their November meeting, the SEBC noted weight loss medication coverage as a large contributing factor to the deficit."  MORE >>

"For many of the almost 50 million people working for the 3.2 million smaller companies in America, family coverage is no longer affordable. It is likely to be prohibitive for the really small companies, the pizza shop, the dry cleaners, or the bakery. On average, workers at these firms have fewer resources to cover health costs: Salaries at firms of less than 200 employees are $44,600 on average compared to $63,200 for workers at larger firms."  MORE >>

"[T]he rising impact of healthcare inflation will demand employers seek alternative approaches to containing costs.... For employees, this new 'contract' will bring better resources and education to navigate their healthcare decision-making while demanding that employees become more engaged in their personal health journeys."  MORE >>

"As the year is quickly coming to an end, it is critical that plan sponsors set some time aside to review and confirm operational and administrative practices throughout the year. As appropriate, operational errors may be corrected and documented before the close of the year with significantly reduced consequences."  MORE >>