"This reporting obligation encompasses both self-funded and fully insured group health plans, and it is mandatory, regardless of whether the prescription drug coverage functions as the primary or secondary option alongside Medicare. The disclosure must be provided to CMS: [1] Within 60 days after the beginning of the plan year (March 2, 2025, for calendar-year plans); [2] Within 30 days after termination of the prescription drug plan; [3] Within 30 days after any change in creditable status of the prescription drug plan."  MORE >>

"While we expect to see revisions and rulemaking aligned with the directives of the memorandum and executive orders in the weeks to come, employer plan sponsors should not begin to implement changes until additional agency guidance is published with an explanation of any required action."  MORE >>

"The final rule largely continues existing risk adjustment policies, but it does finalize some notable policy changes, including beginning to account for receipt of HIV pre-exposure prophylaxis (PrEP) when determining enrollee risk scores. The policies finalized by HHS in the final rule almost exactly mirror its proposals from the October proposed rule."  MORE >>

"The DEA has introduced new rules for telemedicine, impacting remote prescribing of controlled substances for patients not seen in-person by the prescriber. Special registration classes will allow medical providers to prescribe Section II-V substances via telemedicine. Telemedicine platforms that facilitate medication prescriptions will be required to register with the DEA."  MORE >>

"NY HIPA seeks to impose more stringent regulation of consumer health care data given the increased monetization of consumer data, prevalence of online tracking technologies, and concerns arising from the [Dobbs] decision that information stored or obtained digitally can be used to prosecute individuals who seek abortions.... If signed into law, NY HIPA is positioned to be among the most extensive consumer health data privacy laws in the country."  MORE >>

"[T]he court questioned whether the volume and nature of the requests exceeded what could be considered minimal or incidental.... Upon returning, the employee was informed that her job description had changed, and she was placed on 'inactive' status before being terminated. The court found a genuine dispute over whether the job modification and subsequent termination were pretextual and linked to her FMLA leave.' [Kelley v. Jewish Voice Ministries, Int"l, No. 23-0353 (D. Aris. Oct. 4, 2024)]  MORE >>

"Combined with the potential cost savings from lower deductibles and total out-of-pocket costs -- which could be invested in taxable accounts -- clients with higher medical expenses and in lower tax brackets may find that traditional health plans offer a better balance of savings and healthcare coverage."  MORE >>

"Many life insurance policies are not funded with adequate premiums to keep coverage in force until death. In recent years, the risk of underperformance for many policies has been shifted from the life-insurance carrier to the policy owner and the trustee as a fiduciary."  MORE >>