"Plan sponsors and health insurance providers for fully insured plans are no longer required to send [Forms 1095-B and 1095-C] to all eligible (full-time) employees and covered individuals. Instead, only if an employee requests a form must one be provided by the later of January 31st of the year following the coverage year or 30 days after the date of the request.... [In] order to take advantage of this new rule, plan sponsors must provide a notice to employees letting them know they have the right to ask for a 1095 form. There is no model notice yet, but employers can likely make a good-faith effort to draft such a notice."  MORE >>

"Plan sponsors should review their routine compliance checklists and update as necessary to ensure a smooth transition into 2025. [1] Gag clause attestations ... [2] Mental health parity -- fiduciary certification ... [3] Reproductive health care -- updates to HIPAA policies, procedures, and Notice of Privacy Practices ... [4] ACA Section 1557 notices of nondiscrimination and availability."  MORE >>

6-page chart summarizes key dates for calendar year 2025 regarding activities and policies that are outlined in other documents.  MORE >>

"January 1, 2025: New York employers will be required to provide up to 20 hours of paid prenatal leave to pregnant employees during any 52-week period.... The employee contribution rate and benefit amounts under New York Paid Family Leave will increase.... July 31, 2025: New York's COVID-19 paid quarantine leave expires."  MORE >>

"Citing Loper, the court analyzed whether the 2024 regulations ran afoul of a statutory requirement that HIPAA would not be construed to invalidate or limit procedures under other laws for reporting child abuse, public health investigations, or certain other activities. The provider argued that the 2024 regulations limited disclosures regarding child abuse in states such as Texas. Again agreeing with the provider, the court concluded that the 2024 regulations limited providers from reporting child abuse in many ways." [Purl v. HHS, No. 24-0228 (N.D. Tex. Dec. 22, 2024)]   MORE >>

"In recent years, the opaque business practices of PBMs have drawn fire.... But Lewandowski's lawsuit goes to a sensitive spot that had been overlooked until recently: language in the 2021 appropriations bill that revised [ERISA].... Her lawsuit is based on congressional language specifying that the law's requirement of prudent management covers health as well as retirement benefits." [Lewandowski v. Johnson & Johnson, No. 24-0671 (D.N.J. complaint filed Feb. 5, 2024)]  MORE >>

"Health insurers frequently review patients' progress to see if they can be moved down to a lower -- and almost always cheaper -- level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients' conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided."  MORE >>

"In aggregate, the market achieves between zero and 42 percent return on investment (ROI) by the third year after launch, under varying cost estimates. But this aggregate profitability is driven by a small number of highly profitable outliers. 70 percent of drugs in this market do not achieve profitability by their third year after launching. Moreover, generic injectables are less profitable than generic orals, which have not experienced shortages to the same extent as injectables."  MORE >>

"Congress would save billions over a decade by implementing policies such as site-neutral payment and reduced Medicare coverage of hospital bad debt, according to [a CBO report].... Spending on hospital services surged by 10.4% for the year, up from a 3.2% increase in 2022 and 3.4% for the three-year period spanning 2020-22. The 2023 increase was the biggest seen since a 10.8% jump in 1990.... Use and intensity of services were more significant factors in the spending increase, CMS actuaries posited[.]"  MORE >>

"[The authors] present a high-level approach for how to evaluate each IRA Medicare drug-related provision, including identification of key research questions and outcomes; the potential methods that can be used; and the challenges that may arise.... The framework presented here can be used to develop and implement a comprehensive evaluation of the IRA's Medicare drug-related provisions."  MORE >>