"The proposed rules ... would require plans to: [1] Establish an easily accessible, transparent, and sufficiently expedient exceptions process. [2] Cover certain recommended OTC contraceptive items without a prescription. [3] Cover certain contraceptive drugs and drug-led combination products. [4] Include disclosure on coverage and cost-sharing for OTC contraceptives in their internet-based self-service transparency tools."  MORE >>

"[T]he final rule does the following: [1] Updates and revises certain definitions pertaining to MH/SUD benefits. [2] Establishes a 'meaningful benefits standard' ... [3] Requires plans to conduct comparative analysis of NQTLs to ensure MHPAEA compliance. [4] Requires collection and evaluation of data pertaining to MH/SUD benefits. [5] Increases scrutiny of the adequacy of the network for MH/SUD benefits. [6] Requires certification by plan fiduciaries that they are using prudent processes to follow the requirements of the MHPAEA."  MORE >>

"The purpose of the MSP mandatory reporting requirements is to help CMS determine whether a plan is primary to Medicare.... Responsibility for reporting falls upon the entity serving as an insurer or TPA for a group health plan, or, in the case of a self-insured, self-administered group health plan, a plan administrator or fiduciary.... [R]eporting is required for insured and self-insured major medical plans but not for health FSAs ... HRAs are generally considered to be group health plans that must be reported for MSP purposes[.]"  MORE >>

"If the Legislature does not amend the ESTA prior to its implementation, the changes to Michigan's paid sick leave statute will be substantial. Previously, only certain employers with 50 or more employees were required to abide by the provisions of Michigan's PMLA. Now, beginning February 21, 2025, all Michigan employers, regardless of size, will be subject to the provisions of the Earned Sick Time Act."  MORE >>

"[A] federal appellate court concluded that a manager can cause an employer to violate the [FMLA] merely by deterring an employee from enjoying benefits under the FMLA without actually causing the company to deny the employee's request for those benefits.... Employers, remind your managers that [1] FMLA rights are non-negotiable; [2] they cannot discourage FMLA use; and [3] having different remote work rules for similarly-situated employees is a lawsuit waiting to happen." [Kemp v. Regeneron Pharmaceuticals, Inc., No. 23-0174 (2d Cir. Sep. 9, 2024)]  MORE >>

"According to an abstract [HHS] filed with the White House Office of Information and Regulatory Affairs, the proposed rule is intended to 'improve cybersecurity in the health care sector by strengthening requirements for HIPAA regulated entities to safeguard electronic protected health information to prevent, detect, contain, mitigate, and recover from cybersecurity threats.' Formalizing cybersecurity requirements via rulemaking would also position the Office for Civil Rights (OCR) to expand its enforcement capabilities. The proposed rule is expected to be published by the end of the calendar year."  MORE >>

"Insurers can contribute to an ongoing discussion by supplementing their digital platforms with robust counseling and educational resources. Among the digital resources for breast cancer that health plans can offer, interactive quizzes, cost estimator tools and educational overview pages stand out[.]"  MORE >>

"No bill has been lobbied more by Blue Cross Blue Shield than the Lower Prices, More Transparency Act.... Passed with overwhelming support in the House, the bill has since stalled but could advance in the coming months. It codifies price transparency protections, prohibits spread pricing by pharmacy benefit managers (PBMs), eliminates disproportionate share hospital program cuts through 2025, addresses community health centers and advances site-neutral payment reform.... With wider PBM reform yet to clear Congress and get signed by the President after months of pressure, it suggests lobbying efforts to halt reform may be working."  MORE >>

"The survey found U.S. employers are prioritizing support for mental (73%) and physical (50%) wellbeing. Yet, employees say that financial wellbeing support is their top area of concern (66%), despite being the lowest priority for employers (23%)."  MORE >>

"Between 2009 and 2023, the uninsured rate for 19 to 25-year-olds declined from 31.5 percent to 13.1 percent, representing 5.6 million fewer uninsured young adults. Over that period, more young adults were able to stay on their parents' employment-based coverage with dependent coverage increasing by 23 percent."  MORE >>

"The AMA urged the [ERISA Advisory Council] to recommend changes to the [DOL]'s rules governing prior authorization, claims and appeal processes to reduce harms and burdens imposed on patients and physicians.... The testimony outlines meaningful reforms and changes the advisory committee can recommend to the [DOL], some of them changes that state-regulated plans and HHS plans have already undertaken. "  MORE >>