"This revenue procedure provides the applicable percentage table in Section 36B(b)(3)(A) of the Internal Revenue Code for taxable years beginning in calendar year 2025. This table is used to calculate an individual's premium tax credit under Section 36B. This revenue procedure also provides the indexing adjustment for the required contribution percentage in Section 36B(c)(2)(C)(i)(II) for plan years beginning in calendar year 2025.... For plan years beginning in calendar year 2025, the Required Contribution Percentage for purposes of Section 36B(c)(2)(C)(i)(II) and Section 1.36B-2(c)(3)(v)(C) is 9.02%."  MORE >>

"[T]hese final rules...

• Reinforce that health plans and issuers cannot use NQTLs that are more restrictive than the predominant NQTLs applied to substantially all M/S benefits in the same classification....
• Require plans and issuers to collect and evaluate data and take reasonable action, as necessary, to address material differences in access to MH/SUD benefits as compared to M/S benefits that result from application of NQTLs, where the relevant data suggest that the NQTL contributes to material differences in access.
• Codify the requirement in MHPAEA ... that health plans and issuers conduct comparative analyses to measure the impact of NQTLs....
• Prohibit plans and issuers from using discriminatory information, evidence, sources, or standards that systematically disfavor or are specifically designed to disfavor access to MH/SUD benefits as compared to medical/surgical benefits when designing NQTLs.
• Implement the sunset provision for self-funded non-Federal governmental plan elections to opt out of compliance with MHPAEA."

Also available:

• New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Participants and Beneficiaries
• New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Providers
• New Mental Health and Substance Use Disorder Parity Rules: What They Mean for Plans and Issuers

MORE >>

"Most provisions of the final rules apply generally to group health plans and health insurance issuers that offer group health insurance coverage starting on the first day of the first plan year beginning on or after Jan. 1, 2025, but certain requirements that may take more time to implement apply on the first day of the first plan year beginning on or after Jan. 1, 2026. The new rules also apply to grandfathered and non-grandfathered individual health insurance coverage for policy years beginning on or after Jan. 1, 2026."  MORE >>

"A threshold compliance step for ERISA fiduciaries ... will be to identify the plans in scope.... [T]he DOL’s guidance extends to all service providers, such as brokers, consultants, auditors, actuaries, wellness providers, concierge services, cloud storage companies, etc. Fiduciaries will need to identify what individuals and/or entities are providing services to the plan."  MORE >>

"Health plans have several 'to do' items to get ready for the new HIPAA privacy rules that limit disclosure of reproductive health care information.... [This article provides] an overview of the new rules ... along with a detailed Compliance Checklist with practical tips.... On September 4, 2024, the State of Texas brought a legal challenge in the Northern District of Texas to the new HIPAA rule, along with the validity of the original HIPAA privacy rules." [Texas v. HHS, No. 24-0204 (N.D. Tex. complaint filed Sep. 4, 2024)]  MORE >>

"[T]he affordability percentage used to determine whether coverage offered by employers is affordable for 2025 will be 9.02%.... An increase in the percentage means that the amount an employee can be required to pay for self-only coverage and still be considered 'affordable' can also increase which is a departure from previous years that have typically resulted lower employee contribution amounts."  MORE >>

"San Francisco has posted a more than 8% increase for the 2025 Health Care Expenditure rates under the Health Care Security Ordinance (HCSO) rules. The HCSO applies to all employers that must obtain a San Francisco business registration certificate and have at least 20 employees in any location if at least one works in the city and county of San Francisco."  MORE >>

"Metadata from an unauthenticated website should not constitute IIHI, given that there is no way of definitively linking such data to an individual's health situation ... The court left large portions of the guidance intact, meaning patient portals that incorporate authenticated-access functionality could be deemed in violation if they use tracking technologies. Other scenarios that may present risk include those where the hospital or other HIPAA covered entity solicits information about why the user is visiting the page." [Am. Hosp. Assoc. v. Becerra, No. 23-1110 (N.D. Tex. June 20, 2024; appeal dismissed Sep. 4, 2024)]  MORE >>

"[C]opay accumulator programs ... are policies used by insurers to prevent payment assistance from coupons, rebates or other sources from counting toward a patient's annual deductible and out-of-pocket maximum.... [I]nstead of the assistance going to help patients, insurers collect that money and require patients to keep paying. This often leads to significant, unexpected and unfair out-of-pocket expenses.... The good news is that ... states are considering and passing accumulator bans, creating a welcome trend of prohibiting these oppressive policies."  MORE >>

"A health care system that once relied on fair competition to constrain prices, improve quality, drive innovation, and ensure patient access has become highly concentrated.... The growth in consolidation over the years has led to less competition, which in turn comes with higher prices and significant economic impacts, declines in affordability and access, and decreases or stagnation in quality for patients."  MORE >>

"A lifeline for patients, gene therapies pose a financial threat to employers.... [E]mployees in need of them have been put in the awkward position of fighting with the people who sign their checks, or pleading for donations on social media.... There isn't widespread outrage over gene therapy denials now because they're sporadic and treat diseases that are exceedingly rare. But those numbers are changing."  MORE >>

40 pages; employee benefits items begin on page 4.  MORE >>