"HHS is extending policies related to the treatment of telehealth and audio-only services that were put in place in response to the increased need to expand the use of telehealth services during the COVID-19 public health emergency for the 2020 through 20231 benefit years to the 2024 benefit year and beyond. HHS is extending these policies for purposes of the HHS-operated risk adjustment program under section 1343 of the [ACA] due to changes in patterns of care and higher levels of use of telehealth and audio-only services that can be expected to continue into future benefit years."  MORE >>

"The third RxDC report is due June 1, 2024; instructions may cause plan sponsors to reconsider whether they need to make 'plan level' submissions instead of relying on their vendors to make 'aggregate' submissions on their behalf.... Considering the spotlight recently shed on fiduciary duties and the risks associated with not complying with those duties, the additional insight plan-level filings provide can help fiduciaries stay on course in fulfilling their responsibilities."  MORE >>

"In 2025, tax-deductible/tax-free HSA contribution limits, HDHP in-network out-of-pocket maximums and HDHP minimum annual deductibles will rise from 2024 levels for both self-only and family coverage levels. The HSA catch-up contribution limit is set by statute and hasn't changed since 2009. The 2025 maximum annual employer contribution for an excepted-benefit HRA will increase[.]"  MORE >>

"Many group health plans have made it clear that they will only cover reproductive health care that is legal in the state in which it is obtained. Therefore, in most circumstances, it is expected that group health plans would generally not have knowledge of illegally obtained reproductive health care."  MORE >>

"A former New York City assistant district attorney and his husband are suing the city, claiming its health plan discriminates against gay male couples by denying them coverage of in vitro fertilization benefits.... The lawsuit raises bigger questions about who qualifies for fertility-related care under employer-sponsored plans ... The complaint seeks an injunction to end the city's current policy that restricts coverage of IVF treatment for same-sex male couples." [Briskin v. City of New York, No. 24-3557 (S.D.N.Y. complaint filed May 9, 2024)]  MORE >>

"Workers fed up with rising health care costs, which also eat into their wages, are filing lawsuits aiming to hold employers accountable for cutting what they say are bad deals with firms that manage their health benefits.... The heightened legal threat is contributing to employers' efforts to take a harder line with health insurers, pharmaceutical middlemen and other benefits administrators."  MORE >>

"In 2022, across all hospital inpatient and outpatient services (including both facility and related professional claims), employers and private insurers paid, on average, 254 percent of what Medicare would have paid for the same services at the same facilities.... Prices for common outpatient services performed in ambulatory surgery centers (ASCs) averaged 171 percent of Medicare prices but would have averaged approximately 107 percent of Medicare prices if paid using Medicare payment rates for hospital outpatient departments (HOPDs)."  MORE >>

"New transparency around the price of health care services and workers' mounting frustration with costs are emboldening some employers to get tough in negotiations with hospitals and provider groups.... There are some major limits to this strategy. For instance, it's more difficult to play hardball in smaller cities or rural areas with fewer provider options."  MORE >>

"What mandatory data are manufacturers required to submit?  ... What data are manufacturers optionally allowed to submit?  ... Is CMS allowed to consider cost effectiveness studies? ... Can you provide more detail on the specific data elements manufacturers need to submit?"  MORE >>