"The plaintiffs specifically took issue with the instructions for arbitrators to begin the decision-making process by considering the QPA before other factors; to disregard information deemed redundant with respect to the QPA, unrelated to the case, or noncredible; and to provide a written explanation of why they included other factors in their decision. In the district court's decision and in this [Fifth Circuit] ruling, judges said the regulations were overly prescriptive." [Texas Med. Ass'n (TMA) v. HHS, No. 23-40217 (5th Cir. Aug. 2, 2024)]  MORE >>

"[The Eighth Circuit] upheld a district court's determination that Kelsey Weyer was totally disabled and that a policy limitation for mental and nervous disorders was inapplicable.... The court explained that the applicability of the limitation requires 'but-for causation,' i.e., the physical impairments alone would not suffice to cause disability ... That requirement was unmet based on the court's finding that 'Weyer's physical conditions independently rendered her unable to work.' " [Weyer v. Reliance Standard Life Ins. Co., No. 23-2862(8th Cir. July 30, 2024)]  MORE >>

"This issue brief ... provides more details on the factors that are likely to drive premium changes in 2025 for plans operating in the individual and small group markets subject to [ACA] rules.... [T]his brief focuses on changes in gross premiums rather than changes in premiums net of ACA premium subsidies." [Also available: Infographic]  MORE >>

"While the Medicare fee schedule only applies directly to payment related to the care for Traditional Medicare, it is broadly copied by Medicare Advantage (MA), commercial insurance, and Medicaid. The Medicare physician fee schedule has an outsized influence, functioning in many ways as a national fee schedule. But how does it work in practice?"  MORE >>

"[H]ospital mergers from 2010-15 ... caused an average price increase of 1.2% in these communities.... [A] 1% increase in [hospital] prices was associated with: [1] Decrease of employment and payroll of 0.37% outside of healthcare, and no change of employment or payroll in the healthcare industry or in self-employment; [2] Labor income decrease of 0.27%; [3] Decrease in income tax payments of 0.4%; [4] Increase in unemployment payments of 2.5%."  MORE >>

"The [IRS] announced tax relief for individuals and businesses in four states affected by Hurricane Debby. Affected taxpayers in South Carolina, North Carolina, Florida and Georgia now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments.... Currently, this applies to: All 46 counties in South Carolina [SC-2024-07] ... 61 counties in Florida [FL-2024-07] ... 55 counties in Georgia [GA-2024-06] ... 66 counties in North Carolina [NC-2024-07]."  MORE >>

"EBSA offers this list of failures to steer away from: [1] Failing to operate the plan prudently and for the exclusive benefit of participants; [2] Using plan assets to benefit certain related parties to the plan ... [3] Failing to properly value plan assets at their current fair market value, or to hold plan assets in trust; [4] Failing to follow the terms of the plan ... [5] Failing to properly select and monitor service providers; [6] Taking any adverse action against an individual for exercising his or her rights under the plan ... [7] Failure to comply with ERISA Part 7 and the [ACA] ."  MORE >>

"The [DOL] and the General Services Administration [on August 7] announced a collaborative effort to centralize government benefits information on USA.gov and USAGov en Español, which will offer a new benefits experience for the public in English and Spanish. Benefits.gov, a website managed and hosted by the department since 2002, will shut down in September 2024."  MORE >>