"[A]dministration says benefits from the changes would include improved stability and a reduction in improper enrollments.... CMS says the number of applications that were submitted to healthcare.gov and had data-matching issues increased from 2.6 million in 2020 to 6.3 million in 2022, the second year in which enhanced subsidies were available. The agency says it also tracked a sharp rise in consumer complaints about being enrolled in a marketplace health plan without consent[.]"  MORE >>

"[E]mployers generally welcome price transparency because better access to clear and standardized pricing information enables employers and employer-sponsored health plans to make more informed decisions regarding coverage and tailor their health plan coverage accordingly.... However, employers may need to invest in systems and processes in order to process and analyze the pricing data and subsequently relay the information to the employees."  MORE >>

"On February 21, 2025, as Michigan employers were preparing to comply with the provisions of the Earned Sick Time Act (the 'Original ESTA') taking effect that day, Governor Gretchen Whitmer signed a last-minute bill (the 'Amended ESTA') that had immediate effect. Since then, the Michigan Department of Labor and Economic Opportunity has updated its [FAQs] ... [T]he Amended ESTA makes several key changes that employers should consider before implementing their Michigan sick time policies."  MORE >>

"[HHS] has reversed course and now contends that Section 1557 of the [ACA] does not prohibit discrimination on the basis of gender identity.... At present, it is uncertain if HHS' forthcoming guidance (or other forthcoming guidance) will prohibit coverage related to gender dysphoria or will clarify that the provision of gender dysphoria related medical plan coverage is permissive, not mandatory."  MORE >>

"[A table] shows the previous penalty amounts for ERISA violations and the new inflation-adjusted penalty amounts effective for penalties assessed after January 15, 2025."  MORE >>

"A string of recent lawsuits is spotlighting health insurance companies' inaccurate provider directories ... Patients challenging inaccurate directories lack a clear route in court, though their attorneys have tried a range of state and federal claims from false advertising to breach of fiduciary duty and even racketeering. Federal laws like the [ACA] and the No Surprises Act require insurers to maintain accurate directories, but lax enforcement and limited legal pathways have undercut compliance."  MORE >>

"While Right of Access enforcement actions often involve financial settlements and corrective actions plans, the OHSU matter is an example of a covered entity seemingly agreeing to pay a [civil monetary penalty], possibly to avoid what can be the costly and time-intensive process of negotiating a settlement with OCR and complying with the requirements of an often multi-year corrective action plan."  MORE >>

"For many years, the employer used a fixed year for determining the amount of FMLA leave an employee was entitled to.... The new TPA decided that it would transition from a fixed FMLA leave year to a rolling 12-month period.... Annabelle claims that changing to the rolling 12-month leave year means that employees who were FMLA-eligible in 2024 may not be FMLA-eligible in 2025.... [Is] Annabelle correct that the employer/TPA violated the FMLA by failing (or refusing) to provide in late 2024 a notice of the changes that would take effect in 2025 and later?"  MORE >>

12 pages. "This interim summary report on risk adjustment is based on issuers submitting at least 90% of three quarters of claims data and 90% of enrollment data for the 2024 benefit year. In the 2018 benefit year, HHS introduced the high-cost risk pool (HCRP) ... As in previous interim reports, HCRP interim estimates are not included because we expect that many issuers will submit their more expensive and complicated claims towards the end of the data submission period." [Also available: Appendix A: Interim 2024 Benefit Year Risk Adjustment State Averages with State Billable Member Months (XLSX) and Appendix B: Interim 2024 Benefit Year Risk Adjustment Geographic Cost Factor (GCF) (XLSX)]  MORE >>

"Streamlined appeals procedures with navigation help for consumers could increase the number of appeals and likely lead to at least some denials being overturned. Greater transparency on claims denials and prior authorization would enable consumers and employers to make more informed purchasing choices and give regulators tools to target investigations and enforcement. These steps would improve access to care and lower out-of-pocket costs[.]"  MORE >>

"Employers generally need to respond to a written request for certain ERISA documents within 30 days to avoid potential penalties of up to $110 per day. In many common written request situations, there is some level of ambiguity for employers to resolve as to which documents are subject to this mandatory disclosure requirement and which specific plan materials the employer should provide."  MORE >>

"The U.S. Senate on March 12 confirmed [Keith Sonderling], who was a former EEOC commissioner and [DOL] official, to serve as Deputy Secretary.... While at the EEOC, Sonderling ... took interest in artificial intelligence and workplace technology issues as they apply to civil rights laws. He also published various articles on the benefits and potential harms of using AI-based technology in the workplace."  MORE >>