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Health & Welfare Plans Newsletter

July 3, 2024

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[Guidance Overview]

Who Could Forget the ACA's Section 1557?

"The Final Rule restores Section 1557 protections against discrimination based on sexual orientation, gender identity, and disability, as well as religious objections. It also further expands the reach of the Rule to Part B Medicare providers, private health insurance plans, and the use of AI patient decision-making tools.... Plan sponsors and administrators would be wise to carefully review their plan designs and operations to ensure compliance by the July 5th, 2024, effective date."  MORE >>

MZQ Consulting, LLC

Fifth Circuit Reverses Injunction in ACA Preventive Care Challenge

"The Fifth Circuit agreed with the district court that the members of the PSTF were not validly appointed ... and that the federal government had not cured this deficiency. However, the appellate court also determined that the district court overreached by enjoining all government action taken to enforce the preventive care mandate ... With the specific exceptions of the plaintiffs in this case, the preventive care mandate is still in effect." [Braidwood Mgmt, Inc. v. Becerra, No. 23-10326 (5th Cir. Jun. 21, 2024)]  MORE >>

NFP

Fifth Circuit Finds Appointment of USPSTF to Be Unconstitutional

"[It] is likely that the USPSTF coverage requirement will not be enforceable against any health plan in the Fifth Circuit. The decision also leaves open the possibility that the district court could invalidate the preventive care mandate based on the ACIP's and HRSA's recommendations and guidelines, which include immunizations and women's health services[.]" [Braidwood Mgmt, Inc. v. Becerra, No. 23-10326 (5th Cir. Jun. 21, 2024)]  MORE >>

Winston & Strawn LLP

Majority of Employers Plan to Maintain Health Benefits in 2025, Even as Costs Rise

"More than one-third of large employers will offer a high-performance, narrow-network or other alternative medical plan designed to steer employees to quality, cost-efficient care next year.... 18% of employers plan to offer specific resources for women going through menopause, up from just 4% in 2023.... Despite the cost [of GLP-1 drugs,] few large employers have either dropped coverage or plan to drop it (3%), and only 10% say they are considering doing so. Conversely, 27% of employers are considering adding coverage."  MORE >>

BenefitsPro; free registration required

Spotlight on High-Cost Claims: Q3 2024 Trends

"Although administrative claims data does not contain the level of detail required to accurately predict all HCCs, it can provide valuable insights into them and the factors driving that risk. Furthermore, it allows plan sponsors to stratify their populations to focus on the those most at-risk of adverse events to target for disease management programs."  MORE >>

Segal

Rising Prescription Drug Costs Are a 'Significant Burden' to Americans

"Findings published by GoodRx ... show that the list price for prescription drugs has climbed about 37% since 2014.... In 2024 alone, Americans have spent $21 billion on out-of-pocket prescriptions. That amounts to about $16.26 per person[.]"  MORE >>

Fox Business

Cracking the Code on Paying for Cell and Gene Therapies

"With treatments like cell and gene therapies clearly expected to ramp up in the years ahead, the focus must be on long-term financing solutions. What's needed is a pragmatic approach to making these treatments accessible and affordable for the right patients. Such efforts already are under way."  MORE >>

EBN

The Resurgence of Provider-Sponsored Health Plans in the New Health Care Ecosystem

"[C]hanging market conditions have created an opportunity for PSHPs to play a more predominant role. By effectively harnessing the combined power of a payer-provider enterprise, PSHPs can not only hedge against declining system revenue, but more importantly, PSHPs can serve as the framework upon which their system sponsors can curate care delivery in the new decentralized model of health care."  MORE >>

McDermott Will & Emery, via American Health Law Association

[Opinion]

Mental Health Benefits at Work: How We Can Go Further

"Modernizing our mental healthcare system will require action in three critical areas: [1] breaking down barriers to telehealth and virtual care; [2] significantly expanding the mental health workforce, in the short-and long-term; and [3] integrating mental health and physical healthcare."  MORE >>

HealthcareDIVE

Benefits in General

After Overturning Chevron, SCOTUS Opens Wide Yet Another Door to Future Litigation

"Largely overshadowed by the recent U.S. Supreme Court decision rejecting the Chevron doctrine's judicial deference to federal agencies, another 6-3 decision has thrown the door open for more litigation.... [T]he majority held that 'An APA claim does not accrue for purposes of Section 2401(a)'s 6-year statute of limitations until the plaintiff is injured by final agency action.' " [Corner Post v. Bd. of Gov. of the Federal Reserve System, No. 22-1008 (S. Ct. Jul. 1, 2024)]  MORE >>

American Retirement Association [ARA]

The End of Chevron Deference and Its Impact on Employee Benefits

"ERISA and other employee benefits statutes often involve complex and ambiguous provisions. Without Chevron deference, the [DOL] and other agency interpretations of these ambiguities may face heightened challenges in court, creating a period of uncertainty as new judicial precedents are established." [Loper Bright Enterprises, Inc. v. Raimondo, Sec. of Comm., No. 22-451 (S. Ct. Jun. 28, 2024)]  MORE >>

Snell & Wilmer L.L.P.

Open Season for Regulatory Challenges: Supreme Court Overturns Chevron Deference and Expands Opportunities to Attack Federal Rules

"For heavily-regulated employee benefit plans and health insurance, the Loper Bright decision could have significant impacts both in terms of cabining agency flexibility, requiring Congressional action for the imposition of additional regulatory requirements, and creating uncertainty as finalized rules may face greater odds of being overturned." [Loper Bright Enterprises, Inc. v. Raimondo, Sec. of Comm., No. 22-451 (S. Ct. Jun. 28, 2024)]  MORE >>

Groom Law Group

Employee Benefits Jobs

View job as Insurance Analyst for Nolan Financial

Insurance Analyst

Nolan Financial

Remote

View job as Insurance Analyst for Nolan Financial

Selected New Discussions

HSA with Spouse Eligible for FSA

"On July 1 my wife enrolled in a non HDHP thru her employer. Along with this came eligibility to enroll in an FSA which she declined. I have a HDHP thru my employer. Does the eligibility of enrolling in an FSA now exclude me from contributing to my HSA for the term of her employers FSA plan year? Or is it since she declined to have funds contributed to this FSA still make me eligible for HSA contributions?"

BenefitsLink Message Boards

QMCSO: Parent Enrolled as Spouse of Another Employee (Step-Parent)

"An employee is the subject of a QMCSO with the employee's child as the alternate recipient. The employee is married to another employee (the step-parent). The parent/employee is enrolled as the spouse of the step-parent/employee. May the child be enrolled as a dependent in the family coverage of the step-parent/employee, or should the parent/employee be removed from the spouse's family coverage and enrolled as a participant in the employee's own right with the alternate recipient as a dependent of the parent/employee?"

BenefitsLink Message Boards

Webcasts and Conferences
(Health & Welfare Plans)

Pregnancy Accommodations and the PWFA’s Final Regulations: Your Questions Answered

RECORDED

Jackson Lewis LLP

Last Issue's Most Popular Items

Chevron Deference Is No More: ERISA, Employee Benefits and Executive/Equity Compensation Rule-Making Is Likely to Be Affected

FordHarrison

Chevron Doctrine Overruled: Potential Impacts on Plan Sponsors and Employee Benefit Plans

Smith, Gambrell & Russell, LLP

The Ongoing Challenge to the ACA's Preventive Services Mandate

Groom Law Group

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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.

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