"Plans that are not fully insured and covered by MHPAEA should consult with their [TPA] ... to collect and analyze the data needed to comply with the MHPAEA final regulations and the required NQTL comparative analyses.... [P]lan sponsors that have a separate prescription drug benefit administered by a [PBM] should confirm that the PBM or another service provider is completing the comparative analyses in connection with the drug benefits."  MORE >>

"In general, the items receiving extensions for participants and beneficiaries are similar to those receiving extensions that were provided with respect to COVID-19, e.g., claims filing deadlines, but begin based upon the geographic locale of the participants and beneficiaries, and the extensions all have an end date of May 1, 2025."  MORE >>

"The New York Department of Labor has issued guidance on the new Paid Prenatal Leave Law, effective January 1, 2025.... The guidance clarifies various aspects of the new law, including that paid prenatal leave is a separate benefit, that the law covers all private-sector employees in the state, regardless of size, and that employers are prohibited from asking for details about the reasons for prenatal appointments."  MORE >>

"Effective January 1, 2025, a HCSP must ensure the use of any AI or other software tool in prospective, retrospective, or concurrent UR/UM functions based (in whole or in part) on medical necessity satisfies several requirements[.]"  MORE >>

"69% of employers see [cell and gene therapy (CGT)] affordability as a moderate or major challenge ... 32% of employers are confident in their understanding of the financial impact of CGTs ... Three-quarters of employers are moderately or very concerned about affordability of GLP-1s, and that same proportion have experienced increased GLP-1 spend ... [E]mployers are showing their declining satisfaction with their PBMs through lower willingness to recommend their PBM to others."  MORE >>

"Only Arkansas had an overall relative price below 170 percent of Medicare prices, while other states ... had relative prices that were above 300 percent of Medicare prices. In 2022, across all hospital inpatient and outpatient services ... employers and private insurers paid, on average, 254 percent of what Medicare would have paid for the same services at the same facilities.... Prices for common outpatient services performed in ambulatory surgery centers (ASCs) averaged 171 percent of Medicare prices[.]"  MORE >>

"If you've been involved in a DOL investigation over the past year, you've noticed a new format for the long-itemized list of information DOL seeks in an FMLA investigation.... Apparently, DOL investigators have been told to collect more information and investigate further, even in FMLA cases. In these matters, investigators are expected to push for payroll information, even when the FLSA is not implicated in a complaint. The goal? To leave no FMLA or FLSA stone unturned."  MORE >>

"With little known regarding potential healthcare policy change, this article discusses considerations for employer plan sponsors on how a second term for President Trump could impact employer health plans."  MORE >>

"The incoming Trump administration will likely pull back from defending Biden-era rules from court challenges, including the Federal Trade Commission's recent ban of noncompetes, the DOL's updated definition of an investment advice fiduciary under ERISA and a DOL rule permitting ERISA fiduciaries to consider ESG issues when making investment decisions. Changes in regulation at the federal level could lead to an increase in legislative and judicial activity at the state level ... The new administration, like Trump's previous administration, will likely target the [ACA] and other healthcare-related policies, leading to significant changes ahead in healthcare coverage requirements."  MORE >>