"The FAQs include the example of an agreement between a TPA and the owner of a network under which the TPA is generally barred from sharing relevant information with the plan. The agreement effectively restricts the plan from providing cost information to a business associate. In the Departments' view, this agreement: [1] Indirectly restricts the plan (even though the plan is not a party to the agreement). [2] Results in a violation of the gag clause rules by the plan."  MORE >>

"The extension indicates bipartisan support for continuing coverage for telehealth services, but the short timeline warrants continued stakeholder engagement for the extension and eventual permanence of the Medicare telehealth flexibilities and reinstatement of the HDHP safe harbor. As the new administration takes office, it is unclear where telehealth will fall on the list of priorities."  MORE >>

"Beginning in the first quarter of 2025, California healthcare service plans, health insurers, Medi-Cal managed care plans, and PACE organizations must ensure that staff who have direct enrollee contact receive evidence-based cultural competency training focused on transgender-inclusive healthcare.... Provider directories must also be updated by March 1, 2025, to identify which in-network providers have previously offered gender-affirming services."  MORE >>

"The law allows for a 40-hour accrual and carryover cap.... in addition to a policy in the handbook, employers have to provide posted notice and written notice. This separate written notice must go out to ALL employees.... The law requires that employers track and keep records of the hours worked and paid sick leave accrued and used for every employee."  MORE >>

"ERIC's lawsuit alleges that the Final Rule ... exceeds the Tri-Departments' authority under the MHPAEA and CAA, violates the Due Process Clause of the Fifth Amendment, is arbitrary and capricious, and otherwise violates the Administrative Procedure Act. ERIC's lawsuit also alleges that the January 1, 2025 effective date for many of the Final Rule's provisions is arbitrary and capricious because it did not leave enough time for plans to come into compliance with the entirely new, vaguely worded regulations." [ERIC v. HHS, No. 25-0136 (D.D.C. complaint filed Jan. 17, 2025)]  MORE >>

"[T]he court ... [focused] on the discrepancy between the [LTD] benefits promised to Plaintiff ... and the benefits he ultimately received based on a cap in the governing disability plan document.... Ultimately, the Sixth Circuit underscored the primacy of written plan documents in ERISA cases and the stringent requirements for altering benefits through estoppel when the terms of a plan are clear and unambiguous." [Higgins v. Lincoln Electric Co, Inc., No. 23-5862 (6th Cir. Jan. 16, 2025)]  MORE >>

"[A]fter nearly two years of work on the legislation, key lawmakers in both chambers remain committed to passing the bipartisan healthcare package and are actively exploring options on how to move it forward, possibly as a standalone bill or as a rider on a March government funding measure. However, in remains to be seen how this effort will fit into an increasingly busy legislative calendar stacked with competing priorities."  MORE >>

"The first few weeks of 2025 have already brought with them proposed amendments to the HIPAA Security Rule and five enforcement actions alleging inadequate risk analyses."  MORE >>

"In FY 2024, EBSA closed 729 civil investigations.... Over $544 million restored to workers through informal complaint resolution ... 68 people indicted and 161 people plead guilty or convicted for crimes related to employee benefit plans ... $53.5 million distributed to participants through abandoned plan program ... Over 21,000 compliance assistance program applications & filings."  MORE >>