208 pages. "This manual is effective as of August 19, 2024.... This manual provides operational policy and guidance on key topics related to eligibility and enrollment within the FFE, as well as within the SBE-FPs, which use the Federal platform to perform their eligibility and enrollment functions."  MORE >>

"One of the less-publicized provisions of the Inflation Reduction Act of 20221 (IRA) changes the way beneficiary cost sharing accumulates to the new out-of-pocket threshold value, which is $2,000 for 2025.... Most likely, the only beneficiaries who will pay the full $2,000 to satisfy their MOOPs in 2025 will be non-low-income beneficiaries who are enrolled in a plan with basic Part D coverage or who are in an enhanced plan but exclusively utilize drugs with cost sharing greater than or equal to what is under (i.e., leaner than) the defined standard benefit."  MORE >>

"Though none of the parties raised the issue of subject-matter jurisdiction, the Eighth Circuit determined that the district court did not have subject-matter jurisdiction. The court found dispositive the fact that the family could not have brought their claim under ERISA because they were not plan beneficiaries. Because they could not have sued under ERISA, there is no complete preemption of their state law claim." [Kellum v. Gilster-Mary Lee Corp. Grp. Health Benefit Plan, No. 23-2765 (8th Cir. Aug. 26, 2024)]  MORE >>

"The court concluded that the insurer was entitled to rely on the available medical literature when determining treatments to cover if the process applied to both mental health and medical benefits.... The court determined that MHPAEA requires that treatment limitations applicable to mental-health benefits be no more restrictive than treatment limitations 'applied to substantially all' medical and surgical benefits covered by the plan. Although the court did not determine exactly what 'substantially all' meant in this context, they did conclude that it meant more than one." [Midthun-Hensen v. Grp. Health Coop. of S. Cent. Wis., Inc., No. 23-2100 (7th Cir. Aug. 5, 2024)]  MORE >>

"Without a wrap document establishing a single ERISA plan, an employer could be determined to have multiple, separate ERISA plans, each with its own Form 5500 filing requirement and applicable late penalties. Without complete information specific to the employer and the employer's health and welfare plan, there is more exposure to liability for participant claims and lawsuits due to inconsistent administration resulting from missing, vague, conflicting or inaccurate plan language."  MORE >>

"[T]he Oregon All Payer All Claims database, the cap was associated with a 9.5% reduction in out-of-pocket spending per procedure and a 4.8% increase in the number of outpatient procedures received per enrollee per year."  MORE >>

"Home-based healthcare can deliver better outcomes, at lower cost, and with a better patient experience. Technology exists to enable the most sophisticated solutions, yet, post-pandemic adoption of virtual services, including hospital at home and many consults, has waned. The challenges seem to be a mix of reimbursement, policy and cultural expectations."  MORE >>

"In the US, CVS announced plans to close 900 stores in the next 3 years, and Rite Aid filed for bankruptcy. As pharmacies close, more and more individuals are left without easy access to medications, with disproportionate consequences for certain communities. Patients in higher SVI counties with a lower PCP density had a 30% to 40% higher likelihood to reside in regions with pharmacy deserts. These findings highlight how disparities compound to create barriers to access basic health care."  MORE >>

"[I]ndividuals and businesses throughout the U.S. Virgin Islands affected by Tropical Storm Ernesto that began on Aug. 13, 2024 ... now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in any of the U.S. Virgin Islands' four islands qualify for tax relief."  MORE >>

"It is unclear how the end of Chevron deference will affect employee benefits legislative regulations long term; current litigation may give insight. [1] ESG ... [2] Section 1557 ... [3] Use of forfeitures  ... [4] DOL's final fiduciary rule ... [6] IRS Code Section 401(a)(9) RMDs."  MORE >>