24 pages. "[S]tate continuation laws ... (often referred to as 'mini-COBRA' laws), fill in COBRA's gaps, particularly for small employers offering fully insured group health plans as well as fully- insured large-employer group health plans ... This GRIST summarizes the major aspects of state continuation requirements -- including a comparison and interaction with COBRA rules and useful tables encapsulating applicable laws in each state."  MORE >>

"Critics of these final rules have voiced concerns that the rules may actually limit access to mental health care or substance use disorder benefits if the group plans opt to drop the benefits entirely. The Departments have also faced criticism for issuing these final rules while not addressing healthcare workforce shortages."  MORE >>

"The definition of preventive care for ACA purposes is different than the definition of preventive care for HSA-eligibility. Preventive care for HSA-eligibility is broader. Preventive care for HSA-eligibility includes all ACA preventive care and more. When the IRS expands the definition of preventive care for HSA-eligibility, it does not require that all non-grandfathered group health plans expand what must be covered with no cost-sharing to meet ACA's requirements."  MORE >>

"[T]he fact that treatment is considered optional, voluntary, or elective -- as may generally be the case with clinical trial participation -- is not a factor in the determination of whether an employee may take FMLA leave to receive treatment. The Advisory Opinion states that it is not relevant whether a course of treatment is new, experimental, a placebo, or proven to meet certain criteria for efficacy."  MORE >>

"New statewide paid sick leave law would take effect on July 1, 2025. Although there is no designated carryover or balance caps, the law would allow employers to limit annual accrual and use to either 40 or 56 hours, depending on employer size. Employees are entitled to use paid sick leave as it is accrued."  MORE >>

"This Insight reviews changes to TRICARE's beneficiary cost-sharing amounts that are scheduled to take effect on January 1, 2025."  MORE >>

"Four new ransomware HIPAA enforcement actions highlight compliance concerns beyond simply a cyberattack. Though compliance investigations may take time, HIPAA-regulated entities can glean lessons from prior enforcement and guidance to strengthen compliance programs. OCR's new Risk Analysis Initiative and updated Security Risk Assessment Tool emphasize the importance of a compliant HIPAA security risk analysis."  MORE >>

"What if one of your health plan members walked into a doctor's office, and that person was given a prescription to walk and lift weights instead of being prescribed pills? ... Employers can ... [adapt] the FITT Principle of exercise program design (Frequency, Intensity, Time and Type) to create a framework for a broader population health and well-being strategy.... [1] Facilitate access; [2] Incentivize engagement; [3] Tailor programming; [4] Think holistically."  MORE >>

"In August 2024, overweight and obesity entered the national top five telehealth diagnostic categories for the first time this year ... Acute respiratory diseases and infections reentered the national top five telehealth diagnostic categories after being outside the top five in July, taking the place of hypertension in the third position."  MORE >>

"Even though Reliance Standard determined that Plaintiff's psychiatric issues still rendered her unable to work full-time, it denied her benefits because it claimed that the insurance policy's 24-month limitation on benefits for mental disorders that caused or contributed to her total disability started running [at the time of her initial physical disability] and no further benefits were payable.... [The court found that] the 24-month limitation can only be applied if 'but for' the mental health challenges, Plaintiff would not be totally disabled [and] rejected Reliance Standard's arguments justifying the application of the 24-month limitation earlier." [McEachin v. Reliance Standard Life Ins. Co., No. 24-1071 (6th Cir. Nov. 13, 2024)]  MORE >>

"[W]hen plans work with AFPs to only target specialty drugs, they create a different set of benefits for employees with chronic conditions. Creating one set of benefits for employees with chronic conditions, a health factor under HIPAA, and another set of benefits for employees without chronic conditions could constitute a discriminatory benefit design based on a health factor.... [By] coercing plan members to enroll in an AFP, health plan sponsors engage in a transaction for the benefit of the health plan and not the exclusive benefit of plan beneficiaries. Therefore, if challenged, a court could find plans that partner with an AFP violate ERISA's fiduciary duty obligations."  MORE >>

"The [IRS] announced today tax relief for individuals and businesses located in Chaves County, New Mexico affected by severe storms and flooding that began on Oct. 19, 2024. These taxpayers now have until May 1, 2025, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business located in Chaves County, New Mexico qualify for tax relief."  MORE >>