"[T]he newly proposed meaningful benefits requirement is separate from, and in addition to, the newly prescribed nonquantitative treatment limitation (NQTL) testing standards.... A handful of comments nevertheless urge the regulators to add scope of services to its non-exhaustive list of NQTLs.... The problem is that a plan's scope of services -- what types of treatments a plan will pay for and in what settings -- is a high-level plan design feature and not an NQTL."  MORE >>

"An employer with a group health plan that provides prescription drug coverage to Medicare-eligible individuals must make an annual disclosure to [CMS] The disclosure is due 60 days after the beginning of the plan year -- no later than February 29, 2024 for calendar-year plans.... Employer group health plans ... must report breaches of unsecured protected health information to the Office of Civil Rights (OCR) ... [T]he plan must report small breaches occurring in 2022 no later than February 29, 2024"  MORE >>

"Changes to the Medicare Part D prescription drug benefit are likely to decrease out-of-pocket costs for retirees. Conversely, the changes could have a significant impact on how much plan sponsors with an Employer Group Waiver Plan (EGWP) must pay for benefits. Those plan sponsors will need to understand the Part D changes soon so that they can plan for them in their 2025 benefit offerings."  MORE >>

"OPM released its annual call letter to insurance carriers ... [outlining] areas of focus for plan year 2025. Most of the initiatives center on Medicare coordination with FEHB coverage, in particular how federal annuitants will receive prescription drug coverage. Next year will also be the first for PSHB, the new health-benefits program replacing FEHB coverage for USPS employees and retirees. The call letter provides our first look at how certain PSHB benefits will be structured."  MORE >>

"One key point of the case from an ERISA perspective is that the complaint states J&J relied on a trust to fund its group health plan. This may prove to be a pivotal aspect of the case because the plaintiff can establish a clear connection between the core fiduciary duties imposed upon employers as the ERISA plan administrator and all trust funds as plan assets. The connection would be far more extenuated if plan benefits were paid from J&J's general assets, as is more typical for employers sponsoring self-insured health plans." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

This 215-page report describes, and organizes by topic in detail, nearly 200 FMLA decisions of federal and state courts from November 1, 2022 through October 31, 2023.  MORE >>

"CMS and HHS stated their intent to issue new rulemaking and to exercise enforcement discretion pending issuance of a final new rule, which likely reduces the associated risk of implementing or operating Accumulator Adjustment Programs in the short term.... [B]ecause the 2020 Accumulator Rule is currently in effect per the Court's decision, hubs, copay vendors, and drug manufacturers should prepare to comply with the rule and only utilize Accumulator Adjustment Programs, where allowed by state law, for branded drugs with a generic equivalent." [HIV and Hepatitis Policy Inst. v. HHS, No. 22-2604 (D.D.C. Sep. 29, 2023)]  MORE >>

"[T]he SIHRA will need to be 'integrated' with group health plan coverage that is ACA-compliant. This can include a spouse's employer-sponsored plan ... When an employee (or spouse) is covered by a general purpose HRA, the employee is not eligible to contribute to an HSA ... A SIHRA would only be offered to working spouses with coverage through their own employer.... Employers should consider whether using a SIHRA will bring actual savings as well as employee relations issues."  MORE >>

"HHS released voluntary cybersecurity performance goals catered to the healthcare and public health sectors. In addition, healthcare organizations -- no matter how big or small -- can access helpful guidance through HHS' and the Cybersecurity & Infrastructure Security Agency's joint cybersecurity toolkit. With these resources available, if healthcare entities become victims of a breach of ePHI without having adequate security measures in place, they may face an OCR investigation and similar penalties or enforcement actions."  MORE >>

"While we understand that the Association Health Plans (AHP) rule promulgated under the prior administration has been disputed in legal proceedings, we are disappointed in this proposed rule rescinding the rule in its entirety. AHPs provide a pathway under the existing Multiple Employer Welfare Arrangements to band together to negotiate lower premiums and better benefits for plan members. We urge you to reconsider the recession of the proposed rule and make revisions to the rule that make AHPs more robust and viable while protecting workers from bad actors"  MORE >>