"[HHS'] Office for Civil Rights (OCR) issued a 'Dear Colleague' letter addressing the cybersecurity incident impacting Change Healthcare ... The cyberattack is disrupting health care and billing information operations nationwide and poses a direct threat to critically needed patient care and essential operations of the health care industry." [Also available: Fact Sheet]  MORE >>

"This [IRS] news release may be helpful to those on the 'front lines' of plan administration, who are sometimes asked to explain the reasons for operating rules or decisions. Like last year's IRS guidance on substantiation shortcuts, it also serves as a reminder of the importance of obtaining adequate and appropriate substantiation before reimbursing claims, and highlights the challenges involved with certain expenses."  MORE >>

"A DCAP cannot reimburse payments to an employee's child who is under age 19 at the end of the year or to someone whom the employee (or the employee's spouse) could claim as a dependent.... [The authors] recommend that you include information in your DCAP summary or open enrollment materials about the providers whose care can and cannot be reimbursed under a DCAP."  MORE >>

"The final rules provide for an administrative fee charged by these agencies to participate in the IDR process and the methodology for determining that fee. Likewise, the rules determine the certified entity IDR fees range for single and batched determinations. The rules also finalize the number of administrative fees and certified entity IDR fee ranges for disputes on or after the effective dates of the rules. The final rules went into effect on January 22, 2024."  MORE >>

"The plaintiff alleged that once the algorithm denies claims, Cigna's medical doctors confirm the denials without checking the patients' medical history. .. Consumer class actions alleging the same claims in this case have already been filed in the Eastern District Court of California, the Southern District Court of California, and two others in Connecticut District Court." [Sachs v. Cigna Corp., No. 24-0329 (D. Conn. complaint filed Mar. 11, 2024)]  MORE >>

"Are you exercising discretion, or making a recommendation? For most benefits consultants, real discretion sits elsewhere. The employer is generally making decisions on behalf of the plan, even at your recommendation.... Is the HRA administrator performing a ministerial function, where they only act at the direction of the plan, or are they making black-and-white decisions out of a gray area?The real answer to 'are you a fiduciary' is anything but black and white, and requires a fact-specific inquiry."  MORE >>

"The Biden administration released its fiscal year (FY) 2025 budget on March 11, 2024, and it contains multiple legislative proposals that, if enacted into law, would significantly impact mental health and substance use disorder coverage offered through ERISA health plans. Although a president's budget proposal is akin to a wish list, especially during an election year, the FY 2025 proposal reveals aspirational mental health initiatives that the current administration would like to see become law."  MORE >>

"Proposals for paid family and medical leave at the federal level historically haven't had enough support to become law. Many states have added paid leave mandates since 2017, creating a challenge for multistate employers seeking to deliver consistent benefits to their entire workforce. To address this challenge, lawmakers in the House Paid Family Leave Working Group recommended four ideas for future legislation that could drive consensus among lawmakers to provide more families with more paid leave."  MORE >>

"The new proposed regulations would apply to CPE credits earned for programs held during the period from Jan. 1, 2023, through the date that is 30 days after the publication of the Treasury decision finalizing these proposed regulations. The extended -- a.k.a. permanent -- waiver of the 'physical presence' requirement would apply to active enrolled actuaries."  MORE >>