"The proposals in this NPRM would increase the cybersecurity for ePHI by revising the Security Rule to address: [1] changes in the environment in which health care is provided; [2] significant increases in breaches and cyberattacks; [3] common deficiencies [OCR] has observed in investigations into Security Rule compliance by covered entities and their business associates; [4] other cybersecurity guidelines, best practices, methodologies, procedures, and processes; and [5] court decisions that affect enforcement of the Security Rule." [Also available: Fact Sheet and HHS Press Release]  MORE >>

"[P]lan sponsors may: [1] [R]equire HDHP participants to pay fair market value for non-preventive telehealth services until the participant satisfies the minimum HDHP deductible. The fair market dollar value that HDHP participants pay for eligible services will count toward both the HDHP deductible and the maximum out-of-pocket limit. [2] [D]isallow HDHP participants from utilizing telehealth services for non-preventive services until they meet their HDHP deductible. This may be necessary if telehealth vendors do not have fair market dollar valuations available. [3] [E]liminate telehealth services from the HDHP plan."  MORE >>

"Plan sponsors (and health insurance providers for fully insured plans) are no longer required to send [Forms 1095-B and 1095-C] to all full-time employees and covered individuals. Instead, these Forms must only be sent in response to an employee/covered individual's Plan sponsors will now have at least 90 days to respond to a proposed ESRP before further action is taken.... There will now be a six-year period for collecting ESRPs, counting from the due date for filing the applicable Forms 1095-B and 1095-C or the actual filing date, whichever is later."  MORE >>

"All private sector employers in New York are required to provide paid prenatal leave, regardless of company size. Any employee seeking pregnancy-related health care is covered under this law. Covered employees may use paid prenatal leave at any time and need not have worked for their employer for a minimum period of time before using this leave."  MORE >>

"The Court ruled that the notice requirement exceeded [the Departments'] statutory authority ... Employers who have already distributed this notice have no further action at this time. Employers that plan to provide this notice for their 2025 plan year may want to ... re-evaluate their approach in light of this decision. While the notice is arguably still helpful for plan participants, it is no longer required." [Manhattan Life Ins. Co. v. HHS, No. 24-0178 (E.D. Tex. Dec. 4, 2024)]  MORE >>

"The court also highlighted the principle that procedural technicalities should not unduly bar substantive claims, especially when the claimant might have reasonably believed that the appeal was properly filed. The court stressed that such procedural defenses are better suited for consideration at a more advanced stage, rather than during a motion to dismiss." [Sellers v. Humana Life Ins. Co., No. 24-0162-(D.N.M. Dec. 20, 2024)]  MORE >>

"Attorneys ... asked an upstate New York federal court ... to dismantle an allegedly lucrative co-pay maximizer 'scheme' that it says involves a Buffalo plan administrator and two partners which are affiliates of The Cigna Group. The alleged 'sham' ends up charging for out-of-pocket amounts that are beyond patients' cost-sharing limits, the complaint ... alleges. Under [ERISA], the claim says that the maximizer program 'flouts patient-protective federal health insurance laws to seize copay assistance meant for patients.' " [Gurwitch v. Save On SP LLC, No. 24-1583 (N.D.N.Y. complaint filed Dec. 26, 2024)]  MORE >>

"The complaint alleges that two provisions of the Minnesota Act are invalid under [ERISA].... Although the Minnesota Act describes its provisions as the regulation of pharmacy benefit managers (PBMs), the inevitable effect of the law is to close down the freedom and flexibility of employers and labor unions to design plans that make economic sense for plan participants." [ERIC v. Minnesota Dept. of Commerce, No. 24-4639 (D. Minn. complaint filed Dec. 27, 2024)]  MORE >>

"The stopgap budget bill gave key [Medicare] telehealth and Hospital at Home waivers a three-month reprieve. Supporters now have to convince a fractured Congress and new Administration that these waivers are crucial enough to be made permanent."  MORE >>

"Many Americans have faced the denial of mental health treatment by their insurance companies -- at times despite vivid evidence of the risk such decisions pose. In most cases, patients don't appeal. But in a tiny percentage, patients and their families decide to fight the denials in federal court, setting up a David-versus-Goliath battle where insurers frequently have the upper hand."  MORE >>

31 pages. "Using a national administrative database, [the authors] identify county-level private plan enrollment mandates and exploit them as an instrument for individuals' transition to managed care plans. These transitions, while initially slightly reducing fiscal costs, lead to a continuous increase in Medicaid's costs over subsequent years. Counties subject to mandates experience a 9.8% higher cost four years post-mandate compared to those without mandates."  MORE >>

"[S]everal professional and governmental studies (by the AICPA, GAO, and DOL) have shown audit quality problems with employee benefit plans ... To resolve these matters, the AICPA and GAO could [1] require annual reviews; [2] impose stricter punishments on firms and partners with repeated violations; or [3] disclose violator's names to their state boards of accountancy, other regulators, and other key parties. If deficiencies do not decrease, the authors believe that the U.S. Congress should consider having the GAO and DOL oversee peer reviews of audits of ... employee benefit plans."  MORE >>