"Interim final rules provide that if the issuer of a fully insured group health plan is required by written agreement to submit the RxDC report but fails to do so, then the issuer -- not the plan -- violates the reporting requirements. However, ... the legal responsibility for RxDC reporting stays with a self-funded plan even if a third party agrees to provide the report on the plan's behalf."  MORE >>

"Why is OCR initiating an investigation now and what does it cover? ... Has OCR received breach reports from Change Healthcare, UHG, or any affected health care entities? A: No ... Is OCR's 2016 ransomware guidance applicable to the Change Healthcare cyberattack? A: Yes ... Are covered entities that are affected by the cyberattack involving Change Healthcare and UHG required to file breach notifications? A: Yes ... What HIPAA breach notification duties do covered entities have with respect to the Change Healthcare cyberattack? ... What HIPAA breach notification duties do business associates have with respect to the Change Healthcare cyberattack?"  MORE >>

"Retransmitting a form that corrects a dependent error on or before the employer's filing deadline, including any extensions, will allow the employer to avoid accuracy-related penalties. If the employer transmits the corrected form after the filing deadline but on or before August 1 of the filing year, the penalty could be mitigated. If the employer transmits corrections after August 1 of the filing year, the employer will still be subject to the same maximum penalty as a failure to correct the error."  MORE >>

"Because the final rule takes a more expansive view of who may qualify for workplace accommodations than the ADA, employers will need to analyze requests for accommodations under the PWFA differently than disability-based requests under the ADA."  MORE >>

"Companies that rushed to cover employees weight loss drugs are cutting back their allowances or withdrawing funding entirely. Some companies, such as the Mayo Clinic, are implementing a $20,000 cap on spending per employee. The changes have left some overweight employees using their retirement savings to maintain access to drugs such as Ozempic."  MORE >>

"PBMs have just not been in the plan document business. This is a huge gap in the industry that is potentially exposed by this lawsuit.... Questions arise from the lawsuit that compel consideration of the ERISA fiduciary roles and responsibilities. How is the selection of a PBM an ERISA fiduciary function? Are all acts by the J&J Committee and its members subject to the ERISA fiduciary standards? Are actions by the PBM subject to the ERISA fiduciary rules?" [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"If the merits of the J&J lawsuit are litigated, we can infer from analogous fee litigation concerning retirement plans that the question before the court will be whether the J&J defendants engaged in and documented a prudent process in selecting and monitoring the plan's PBM and its prescription drug benefits." [Lewandowski v. Johnson & Johnson, No. 23-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"In a benefits administration letter, OPM ... outlined new steps for federal agencies to take to 'promote the integrity' of FEHBP. In 2022, a [GAO] report found gaps in how the program determines whether family members of federal workers or retirees are still eligible to receive benefits, and the OPM inspector general estimated that FEHBP could be improperly providing benefits between $500 million and $3 billion per year"  MORE >>

"[T]he bill would require health insurers to use 'generally accepted standards of care' when deciding whether to cover treatments recommended by a doctor. It also bans a practice known as step therapy that is used in some prescription drug plans ... [and] prohibits insurance companies from requiring prior authorization before covering the cost of in-patient psychiatric treatment.... [T]he bill would require insurance companies to conduct internal audits of their own provider networks every 90 days.... And it would give the Illinois Department of Insurance authority to review and either approve or disapprove rate hikes in large-group insurance plans"  MORE >>

"AHIP is requesting  ... that the Departments and OPM extend the exercise of enforcement discretion under the NSA beyond May 1, 2024, with the possibility of future extensions pending the release of further guidance, final resolution of still pending legal challenges or as may otherwise be appropriate. [This letter outlines] detailed explanations of many of the challenges health plans currently face as they seek to align their processes with the result of the TMA III decision."  MORE >>

"[The Council is] writing now to make the tri-agencies aware that [Council] members, including plan sponsors and their service providers, including third party administrators (TPAs) (who do the bulk of the work regarding the QPA calculation), have expressed to us that additional time is needed in order make the QPA-related changes required by TMA III. This is due to the complexity and breadth of the required changes[.]"  MORE >>

"Recent legal changes have expanded the scope of employer-provided tax-advantaged educational assistance benefits to cover student loan repayment. This advisory outlines some of the newest options and provides a refresher on how existing benefits are used."  MORE >>