"TPAs, PBMs and other vendors have varying requirements and expectations of what they need from plan sponsors to successfully complete the reporting, and some may even be delegating some of the reporting responsibility to the plan sponsor.... If your vendor sent you an email or letter asking you to create a HIOS account or stating that they will not submit P2 and D1 on your behalf, that means you must submit P2 and D1 directly to CMS (or engage a third-party to submit them for you)."  MORE >>

"Recognize that autism spectrum disorder, opioid use disorder and eating disorders are mental health conditions and therefore ... covered by mental health parity laws. Blanket exclusions of ABA therapy for autism spectrum disorder, nutritional counseling for eating disorders, and medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD) are impermissible.... Prior authorization, gatekeepers such as EAP referrals and telehealth are impermissible barriers to access mental health benefits."  MORE >>

"Part 2 imposes requirements for substance use disorder (SUD) treatment records ... The Part 2 regulations will come into play typically with employee assistance programs, as well as mental health and substance abuse disorder vendors for a medical plan.... Even though a self-insured health plan sponsor contracts with an EAP or SUD vendor and requires the EAP and SUD vendor to comply with Part 2 and the HIPAA privacy rules (as well as signing a BAA), under the HIPAA privacy rules, self-insured health plans remain responsible for HIPAA privacy compliance."  MORE >>

"The [final rule] adds only new consumer notice requirements for fixed indemnity insurance.... The proposed rule [had] included sweeping changes to the tax treatment of hospital and other fixed indemnity benefit coverage purchased on a pre-tax basis and substantiation requirements for medical expense payments, which were also not finalized. The Departments 'intend to address these issues in more detail in future guidance.' "  MORE >>

"The most significant change under the new law concerns leaves for baby bonding and for a serious health condition. Each type of leave will be covered exclusively by PLO (and, perhaps, the federal Family and Medical Leave Act).... After July 1, 2024, neither leave for baby bonding nor, with two exceptions, leave for a serious health condition is an OFLA-qualifying absence."  MORE >>

"The lawsuit alleges Medica, which administers Mayo Clinic's self-insured plan, uses 'deceptive, misleading, arbitrary' pricing methods that leave plan members in the dark about health costs and allow for inconsistent reimbursement rates ... [According to the lawsuit,] Medica's provider portal, which is supposed to direct workers to in-network doctors and other health care professionals ... provided false and misleading information about providers[.]" [S.M.O. v. Mayo Clinic, No. 24-1124 (D. Minn. complaint filed Apr. 2, 2024)]  MORE >>

"Companies have increasingly offered generous fertility benefits to attract and keep top-notch workers. Now, the federal government is getting in on the act. Starting this year, federal employees can choose plans that cover several fertility services, including up to $25,000 annually for in vitro fertilization procedures and up to three artificial insemination cycles each year."  MORE >>

"The bill requires PBMs to report all rebates and to use pass-through pricing instead of spread pricing. HB 596 also requires network adequacy standards at or above Medicare, limits patient steering, prohibits use of arbitrary accreditation standards, and sets parameters for what can be considered a specialty drug. Additionally, it establishes reimbursement appeals processes."  MORE >>

"With 44% of employees making PTO requests every month in 2023, the message to HR leaders is clear: Flexibility is no longer a perk but rather a necessity. Financial and nonprofit sectors are leading the charge, understanding that to attract top talent, they must accommodate the human behind the résumé."  MORE >>

"DoorDash is testing out a program that would offer access to health insurance, retirement, and paid time off (PTO) for its Pennsylvania-based employees.... Through the portable benefits platform Stride, participants can allocate their portable benefits savings to eligible categories most relevant to them, as well as access helpful information about benefits offerings."  MORE >>