25 pages. "This report sets forth by HIOS ID and state market risk pool the applicable adjustments to 2022 benefit year risk adjustment state transfers based on the 2022 benefit year HHS-RADV results.... These HHS-RADV adjustment amounts will be collected in the fall of 2024 and subsequently paid, pending collections." [Also available: Appendix A: Issuer-Specific 2022 HHS-RADV Adjustments to 2022 Risk Adjustment State Transfers for Non-Merged Market States (XLSX); Appendix B: Issuer-Specific 2022 HHS-RADV Adjustments to 2022 Risk Adjustment State Transfers for Merged Market States (XLSX); and Appendix C: HHS-Operated Risk Adjustment Program State-Specific Data (XLSX)]  MORE >>

"Starting in 2025, out-of-pocket costs for prescription drugs under Medicare Part D will be limited to $2,000 annually.... This IRA change may affect whether a group health plan's prescription drug coverage is creditable, particularly for HDHPs that have minimum deductibles set by the [IRS]."  MORE >>

"The IRS has released an information letter responding to an employee's inquiry about receiving a distribution of unused funds from her employer's qualified transportation plan due to commuting changes caused by the COVID-19 pandemic.... [F]unds designated as qualified transportation fringe benefits can only be used for qualifying commuting activity and are nonrefundable for any other reason, even where employees no longer need or are ineligible for qualified transportation fringe benefits due to a pandemic event."  MORE >>

"The proposed rules emphasize the tremendous breadth of the PFML's coverage, defining 'covered employees' as employees performing services and earning wages in Maine, including full-time, part-time, seasonal, and temporary employees, as well as self-employed individuals electing coverage.... While employers would be permitted to run PFML concurrently with leave provided under the federal [FMLA], they would not be permitted to require employees to exhaust paid time off or other company-sponsored benefits prior to utilizing PFML."  MORE >>

"[T]he Supreme Court weighs overturning a 40-year-old precedent underpinning the ability of agencies to develop detailed regulatory policy. Concurrently, the US Fifth Circuit [Court] of Appeals is weighing the constitutionality of the [ACA's] delegation of authority to various federal advisory bodies and an agency to determine preventive coverage requirements. Both cases involve significant questions of administrative and constitutional law that will impact not only the future of health care regulation, but how our government uses expert determination to decide the preventive care that must be covered through health insurance for over 150 million Americans."  MORE >>

"For organizations with employees operating in multiple different states, keeping up with the latest state and federal laws and EEOC guidance, can be a challenge; however, the demand from employees looking for organizations that provide this leave is growing significantly."  MORE >>

"[T]he Centers for Medicare and Medicaid Innovation (CMMI) has proposed a number of a number of payment models intending to address pharmaceutical cost, spending, and reimbursement.... Most recently, ... CMMI proposed 3 new models related to drug prices: [1] Medicare High-Value Drug List, [2] Cell and Gene Therapy (CGT) Access model, and [3] Accelerating Clinical Evidence model.... Prior to the development of these models, CMMI also proposed 9 other drug pricing models.... The impact of the implemented programs was mixed."  MORE >>

"[T]he IRS in 2002 announced that it would not assert that taxpayers have understated their federal tax liability by reason of the receipt or personal use of frequent flyer miles or other in-kind promotional benefits attributable to business or official travel. That policy apparently remains unchanged.... The IRS's policy has some exceptions"  MORE >>

"[F]iduciaries should: [1] Carefully review their PBM programs ... [2] Fully understand the direct and indirect compensation and revenue flows between all brokers, consultants, PBMs, pharmacy manufacturers and distributors, and other service providers ... ]3\ Consider establishing a Health and Welfare Committee ... [4] Maintain a prudent process, including conducting periodic RFPs, and monitoring service providers  ... [5] Continuously provide training and education for plan fiduciaries to mitigate that risk where available."  MORE >>

35 pages. "Patients who sign up for Medicare Advantage are forced to deal with narrow networks which heavily restrict their access to physicians and hospitals, and are often misled about the size of these networks through inaccurate listings.... [P]atients in MA who become seriously ill or develop chronic conditions end up paying thousands of dollars for their care ... When patients encounter these issues in MA and wish to switch back to Traditional Medicare, they often find that they are unable to do so.... We must rein in the abuses of MA insurers, eliminate profit-seeking in Medicare and beyond, and put an end to these egregious harms."  MORE >>