Updated Jan. 7, 2025. "This document provides instructions for the HHS risk adjustment models for the 2024 benefit year, with revisions from the previous 2024 benefit year software instructions posted on the CCIIO website on September 6, 2024[.]" [Also available: Technical Details (XLSX) and 2024 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP)]  MORE >>

"[DOL, Treasury, and IRS] recently issued joint guidance to provide relief to plan participants and beneficiaries of employee benefit plans affected by either Hurricane Helene, Tropical Storm Helene, or Hurricane Milton.... [S]ome timeframes ... have been extended, thus giving plan participants and beneficiaries affected by these natural disasters more opportunity to file and complete claims, appeal any denied claims, or elect COBRA.... [S]imilar relief was issued in the midst of the COVID-19 pandemic as well."  MORE >>

"Until the IRS provides further guidance on the time and manner of notice, ALEs wishing to use this alternative manner for distributing their 2024 Forms 1095-C may want to look at regulations for similar notice provisions for guidance. For ALEs with self-insured plans, the IRS already provides an alternative manner of furnishing Form 1095-C to covered nonemployees and covered employees who were not full-time employees at any time during the year."  MORE >>

"The New Law increases the timeframe for applicable large employers (ALEs) to respond to Letter 226J assessing 4980H penalties from 30 days to at least 90 days. This applies to assessments proposed in taxable years beginning in 2025 and later. ... If an ALE does not timely reply to the Letter 226J, the IRS can assess the penalties, and the IRS begins collection activity, including sending notices of intent to levy the ALE’s property. It is much easier to remove the penalties at the Letter 226J stage, before assessment, so this is welcome relief for ALEs."  MORE >>

"The Proposed Rule takes aim at several key areas of the Security Rule, including updates to: [1] Standards for assessing adequacy of safeguards ... [2] Administrative safeguard requirements ... [3] Technical safeguard requirements ... [4] Standards for Business Associate agreements ... [5] Encryption."  MORE >>

"The Proposed Rule requires group health plans to include certain requirements in their plan documents for their group health plan sponsors to: [1] Comply with the administrative, physical and technical safeguards of the Security Rule; [2] Ensure that any agent to whom they provide ePHI agrees to implement the administrative, physical and technical safeguards of the Security Rule; and [3] Notify their group health plans upon activation of their contingency plans without unreasonable delay, but no later than 24 hours after activation."  MORE >>

"[T]he proposed rule would require regulated entities to: [1] Maintain an accurate and thorough inventory of their technology assets and create a network map of their electronic information systems, which must be updated at least every 12 months.... [2] Conduct vulnerability scanning at least every six months ... [4] Verify business associate/subcontractor technical safeguards at least every 12 months ... [5] Establish and implement a written contingency plan that includes procedures for data backups, disaster recovery, and emergency mode operations."  MORE >>

"The federal Consumer Financial Protection Bureau ... issued new regulations barring medical debts from American credit reports ... The rules ban credit agencies from including medical debts on consumers' credit reports and prohibit lenders from considering medical information in assessing borrowers." [Also available: White House Fact Sheet]  MORE >>

"Perhaps the most important fact to note regarding New York's paid prenatal leave, which is discussed in the DOL's guidance, is that it applies to all private sector employers, regardless of how many employees a company has. Therefore, even employers with only one New York employee must provide paid prenatal leave to their New York employees."  MORE >>

"The PBRA will not change the distribution requirements for states with individual health insurance mandates (California, Massachusetts, New Jersey, Rhode Island, and Washington D.C), where paper distribution may still be required."  MORE >>

"[Airlines for America] claims that this newly revised provision could affect 'hundreds if not thousands of hours accrued by each employee,' by requiring all collective bargaining agreement negotiated paid sick leave or other time off to 'meet or exceed the minimum standards and requirements' of the ESST law.... [T]he asserted negative impacts of the recent change in Minnesota's ESST law are not limited to airline industry employers[.]" [Air Transport Assoc. of Amer., Inc., v. Blissenbach, No. 24-4657 (D. Minn. complaint filed Dec. 30, 2024)]  MORE >>

"The growing disproportionate amount of drug spending on such a small subset of pharmaceuticals has led many policy makers to focus on these specialty drug products. But this policy focus raises several fundamental questions such as: How is a specialty drug defined; who creates the specialty drug definition; and who benefits from a drug being defined as a specialty drug? Answering these questions is a more complex task than it may initially seem, due in part to the numerous stakeholders whose actions shape the market."  MORE >>

"In March 2014, civilian workers paid an average of $121.80 per month for single coverage medical care plans and $519.78 for family coverage. Employers paid an average of $352.33 per month for single coverage and $782.08 for family coverage. By March 2024, the average employee contribution had increased to $170.92 per month for single coverage and $751.45 for family coverage. Average employer contributions had increased to $528.84 per month for single coverage and $1,232.59 for family coverage by March 2024."  MORE >>

"Who needs a WISP? ... [1] Any business that collects, stores, or processes personal information.... [2] Sectors such as health care, insurance, finance, and education have additional federal and state regulations mandating robust information security measures.... [3] Entities reporting data breaches.... Checklist for developing a WISP: Oversight.... Risk assessment.... Documentation.... Legal requirements."  MORE >>