18 pages. "If finalized, these would be the first modifications of the Security Rule since 2013 and could entail significant additional compliance obligations and costs for HIPAA covered entities and business associates.... [A] redline of the existing language of the Security Rule with the NPRM's proposed modifications is available ... HHS states that the NPRM is intended to address ... significant increases in breaches and cyberattacks; common deficiencies OCR has observed in investigations into Security Rule compliance; ... and court decisions that affect the enforcement of the Security Rule."  MORE >>

"For 2025, the business standard mileage rate is 70 cents per mile (up from the 67-cent rate that applied during 2024). The rate when an automobile is used to obtain medical care ... is 21 cents per mile for 2025 (unchanged from 2024).... Transportation expenses that are deductible medical expenses under Code Section 213 generally can be reimbursed on a tax-free basis by a health FSA, HRA, or HSA.... The applicable reimbursement rate is the one in effect when the expense was incurred."  MORE >>

"TRICARE is explicitly prohibited from covering gender-affirming surgical care for beneficiaries except to treat individuals with an intersex condition due to congenital malformations or chromosomal abnormalities. This statutory prohibition applies only to health care services covered by the TRICARE program for beneficiaries; DOD may pay for gender-affirming surgical care through the Supplemental Health Care Program (SHCP) for 'active duty members of the uniformed services.' " [IN12401 Jan. 10, 2025]  MORE >>

"These cases allege that these copay programs are fraudulent and 'deprive[] patients of the benefits of patient copay assistance funding and increase[] patients' healthcare costs' ... allegedly evading cost-sharing limitations imposed by the [ACA] as incorporated by ERISA.... [T]he complaints assert that the PBMs are ERISA fiduciaries and seek to hold them accountable for breaching the ERISA fiduciary duties of loyalty and to administer plan in accordance with their terms." [Gluesing v. Prudentrx LLC & Caremark RX LLC, No. 24-0549 (D.R.I. complaint filed Dec. 26, 2024), and Gurwitch v. Save on SP LLC, No. 25-0006 (W.D.N.Y. complaint filed Jan. 3, 2025)]  MORE >>

"Group health plan sponsors, third-party administrators and other health plan service providers must determine how best to navigate potentially conflicting and rapidly shifting laws, regulations, and changing cultural norms and clinical standards related to gender-affirming care ... Laws and regulations regarding gender-affirming care for minors are still shifting, although current federal policy and current clinical standards appear to favor covering gender-affirming care for minors on a case-by-case basis where medically necessary."  MORE >>

"An employer-sponsored health insurance plan should not expect net medical savings from [GLP-1] medications, even with their impressive impacts on patient weight and health.... Lower prices would allow more people to benefit from these medications.... The Gallup Organization recently reported that public opinion of the quality of U.S. healthcare has declined to its lowest point since they started asking this question in 2001."  MORE >>

"Algorithm glitches are one facet of a dilemma that computer scientists and doctors have long acknowledged but that is starting to puzzle hospital executives and researchers: Artificial intelligence systems require consistent monitoring and staffing to put in place and to keep them working well. In essence: You need people, and more machines, to make sure the new tools don't mess up."  MORE >>

"HHS is mobilizing an approach to improve the quality, safety, efficiency, accessibility, equitability, and outcomes in health and human services through the innovative, safe, and responsible use of AI. The Plan outlines four ways HHS will accomplish this by focusing on four key goals: [1] Catalyze health AI innovation and adoption to unlock new ways to use AI to improve people's lives; [2] Promote trustworthy AI development and ethical and responsible use to avoid potential harm; [3] Democratize AI technologies and resources to promote equitable access for all; and [4] Cultivate AI-empowered workforces and organizational cultures to allow staff to make the best use of AI."  MORE >>

"Employers are increasingly requiring workers on GLP-1 medications to enroll in nutrition and lifestyle coaching programs. Startup Virta Health saw 60% revenue growth last year, topping $100 million, driven by demand for its employer weight loss management program. Rival startup Omada Health partnered with Cigna's Evernorth division on the EncircleRx program which grew 4-fold to 8 million covered lives."  MORE >>

"Employers using insurance carriers and their PPO networks to cover healthcare costs are paying 2.54 times what the hospital's largest client (the federal government) pays. This pricing disparity creates significant financial challenges, reducing employer profit and employee compensation.... One incredibly powerful and newer solution to address the unsustainable variation in hospital prices is implementing Reference-Based Pricing (RBP) tied to a percentage of Medicare rates."  MORE >>

"In order to compute the 2025 annual adjustment, the Department multiplied the most recent penalty amount for each applicable penalty by the multiplier, 1.02598, and rounded to the nearest dollar.... [T]he increased penalty levels apply to any penalties assessed after January 15, 2025."  MORE >>

"The maximum penalty for failing to file Form 5500 increases from $2,670 to $2,739 per day that the filing is late.... The maximum penalty for failing to provide the SBC increases from $1,406 to $1,443 per failure.... Violations of [GINA] ... and failures relating to disclosures regarding the availability of Medicaid or [CHIP] assistance, may result in penalties of $145 per participant per day, up from $141.... For [401(k)] plans with automatic contribution arrangements, penalties for failure to provide the required ERISA Section 514(e) preemption notice to participants increase from $2,112 to $2,167 per day. "  MORE >>

"What is a private letter ruling and why is it so important right now in the plan sponsor space? ... What are the benefits to the employee when it comes to retirement contribution choice, as illustrated by the August PLR? ... How can plan sponsors benefit from the type of retirement contribution choice program approved by this recent private letter ruling? ... If a plan sponsor is interested in this type of program, what should they do? ... What about compliance concerns beyond profit sharing?"  MORE >>

"Loper Bright and Corner Post are already changing how courts handle challenges to ERISA regulations.... [A Texas District Court] applied Loper Bright to enjoin the effective date of a 2024 DOL rule that broadly redefines fiduciary under ERISA.... [Another District Court] agreed with the above analysis and enjoined the same rule.... However, Loper Bright is not without limits ... 2025 should see additional Loper Bright challenges."  MORE >>

"[An] employer may provide disaster assistance payments under IRC section 139 on a tax-free basis ... [E]mployers can pay for hotel stays, money for food and clothing, or even to help repair homes damaged or destroyed by the fires. There is no limit on such payments, meaning employers can determine how much assistance to provide those affected.... [E]mployers can create a leave-sharing program for employees impacted by disasters."  MORE >>