"This document withdraws a notice of proposed rulemaking ... regarding coverage of certain preventive services under the [ACA].... The proposed rules would have required plans and issuers that utilize reasonable medical management techniques with respect to any recommended preventive services to provide an easily accessible, transparent, and sufficiently expedient exceptions process that allows an individual to receive coverage without cost sharing for the preventive service according to the frequency, method, treatment, or setting that is medically necessary for them, as determined by the individual's attending provider. The proposed rules would also have required plans and issuers to cover certain recommended over-the-counter contraceptive items without requiring a prescription and without imposing cost-sharing requirements."  MORE >>

376 pages. "This final rule includes payment parameters and provisions related to the HHS- operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs)."  MORE >>

"Due to timing constraints, [CMS was] unable to publish the final coefficients in the Final 2026 Payment Notice; therefore, ... the final coefficients for the 2026 benefit year [are published] in this document."  MORE >>

"This notice provides the percentage increase for calculating the qualifying payment amounts (QPAs) for items and services furnished during 2025 for purposes of ... the Internal Revenue Code, ... [ERISA], and ... the Public Health Service Act.... The QPA serves as the basis for calculating patient cost sharing for items or services subject to the surprise billing provisions of the No Surprises Act in certain circumstances. The QPA is also one of the factors considered by a certified independent dispute resolution (IDR) entity to determine which of two offers submitted by parties to a payment dispute in the Federal IDR process best represents the value of a qualified IDR item or service as the out-of-network rate."  MORE >>

15 pages.  No Surprises Act: 5 Q&As address calculation of QPA, disclosures to providers, and IDR process.    Gag Clause Attestation:  5 Q&As address contracting with downstream service providers, prohibited agreements, restrictions on access, and annual attestation requirements.  MORE >>

"Action items for ALEs ... [1] Ensure your benefits team is familiar with the new rules and understands the specific changes and how they impact your reporting obligations.... [2] For plan sponsors that want to take advantage of the reporting relief, prepare and make available the required notice by January 31, 2025. Ensure the notice is clear, conspicuous, and accessible, providing all necessary contact information for employees to request a copy of their form.... [3] Keep an eye out for an IRS Letter 226-J or related follow-up notices from the IRS and ensure you respond within the required 90 days or request an extension."  MORE >>

"In December 2024, the [EEOC] published a fact sheet addressing how federal nondiscrimination laws ... may apply to an employer's use of wearable devices that it furnishes to employees.... [W]hile it is not focused on wellness programs and group health plans, the concepts addressed in the fact sheet may be applicable to wellness programs and group health plans that utilize wearable devices in connection with financial incentives (or penalties) or as a step to access other covered benefits, such as prescription drugs."  MORE >>

"New York's Department of Health (DOH) has posted the 2025 regional covered-lives assessment (CLA) rates and percentage surcharges for graduate medical education (GME) under the state's Health Care Reform Act (HCRA).... The GME CLA rates and percentage surcharges vary among eight regions, and the applicable rate depends on where the covered individual resides or receives in-state hospital care."  MORE >>

"The Supreme Court on [January 13] appeared sympathetic to a retired Florida firefighter who is seeking to sue her former employer ... Karyn Stanley ... contends that the city violated the law when it changed its policy for subsidizing health insurance for retirees, leaving her to bear the entire cost of her health insurance for 15 years. But some justices questioned whether Stanley's best argument was one that they could consider at all[.]" [Stanley v. City of Sanford, Florida, No. 22-10002 (11th Cir. Oct. 11, 2023; cert. pet granted No. 23-997, Jun. 24, 2024; oral arg. Jan. 13, 2025; transcript and audio available)]  MORE >>

"[T]he next four years will be undoubtedly marked by significant strides of change respecting the public policies underlying employee benefits, and the American healthcare system, generally.... [A] table offers an overview of anticipated policy motivations, as well as the legal and regulatory outcomes associated with each such policy."  MORE >>

"The U.S. pays some of the highest prices in the world for medications, driven by limited price regulation and high demand for innovative treatments.... The complexity of the U.S. healthcare system also plays a major role.... Hospitals and specialized medical services, such as surgeries and advanced diagnostics, represent another substantial chunk of healthcare spending.... The prevalence of chronic diseases, such as obesity, diabetes, and heart conditions, has placed a growing strain on the system."  MORE >>

"Can employees withdraw money from 401(k) plan accounts for wildfire-related expenses? ... Can an employee pay back amounts withdrawn for wildfire expenses to her 401(k) plan account? ... Would an employer or plan sponsor need to amend its 401(k) plan to permit the relief described above? ... We don't have regular access to our workplace because of the wildfires. Is there any relief for an employer or plan sponsor that misses required benefit deadlines -- for example, sending out COBRA election notices or other required notices?"  MORE >>