"[The restructuring] will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation.... The restructuring plan will consolidate [the current 28 divisions]  into 15 new divisions ... and will centralize core functions such as Human Resources, Information Technology, Procurement, External Affairs, and Policy. Regional offices will be reduced from 10 to 5.... Third, the overhaul will implement the new HHS priority of ending America’s epidemic of chronic illness ... Finally, the restructuring will improve Americans’ experience with HHS by making the agency more responsive and efficient, while ensuring that Medicare, Medicaid, and other essential health services remain intact." [Also available: Fact Sheet]  MORE >>

"DOL cybersecurity investigations and subpoenas have been upheld by courts ... Health plans might have gaps that HIPAA BAAs do not reach ... Disability plans are not subject to HIPAA and may be subject to similar threats faced by retirement plans ... Plans invest considerable time and money in benefits, which they should want to protect."  MORE >>

"[WHD Opinion Letter FMLA202501-01] clarifies an employer's rights with respect to requiring employees to utilize their PTO while also receiving some form of benefit. When the employee receives payments under a disability benefit plan ... while on FMLA leave, employers cannot require employees to substitute accrued employer-provided paid time off in the way they can if the FMLA leave is unpaid.... [T]he employer and employee can mutually agree, if state law permits, to supplement the benefits with employer-provided paid time off to bring the employee up to full pay during the period of the leave."  MORE >>

"The Medicare Secondary Payer rules are designed to ensure that employer-sponsored group health plans (GHPs) pay primary for employees and their spouses enrolled in active GHP coverage and Medicare. Where Medicare incorrectly pays primary for a participant enrolled in active GHP coverage, CMS will send a GHP Demand Letter to the employer informing them of the error. Employers should work with their insurance carrier or TPA to properly reprocess the claim with the GHP as primary."  MORE >>

"[In a February letter,] ERIC urged the Departments to exercise their authority ... to postpone the effective date of the Final Rule while litigation challenging its validity is ongoing.... Employers and health plans are already planning for the 2026 plan year and must build new systems to collect and store data, reprogram existing systems, reanalyze outcomes, and redesign benefits to meet the Final Rule's standards. ERIC argues that these costs will continue to mount unless the Departments issue a stay on enforcing the Final Rule." [ERIC v. HHS, No. 25-0136 (D.D.C. complaint filed Jan. 17, 2025)]   MORE >>

"Action items ... [1] Establish a fiduciary committee for health and welfare benefits, adopt a committee charter, and delegate fiduciary responsibility to the committee. [2] Engage qualified prescription drug plan consultants to assist in comparing PBMs and prescription drug arrangements. [3] Collect consultants' compensation disclosures, analyze direct and indirect compensation arrangements, and ensure consultants do not have conflicts of interest. [4] Request and review PBM agreements, fee and rebate arrangements, and formularies, and negotiate reasonable terms.... [5] Collect and review benchmark information from other plans and pharmacies and compare to current and prospective vendor agreements or proposals."  MORE >>

"The ruling emphasized that Unum's decision was arbitrary due to its mischaracterization of her occupation, unjustified dismissal of relevant medical evidence, and reliance on a paper review instead of engaging with the claimant's treating physicians.... This case underscores the importance of accurate job classification and the necessity for insurance companies to provide thorough and reasoned evaluations when handling disability claims." [Mundrati v. Unum Life Ins. Co. of Am., No. 23-1860 (W.D. Pa. Mar. 24, 2025]  MORE >>

"Health care spending per capita in 2019 was highest in Nassau County, New York (about $13,300); Suffolk County, New York ($12,700) and Washington, D.C. ($12,500) ... Clark County, Idaho ($3,400); Loving County, Texas ($3,900) and Kennedy County, Texas ($4,000) had the lowest such spending."  MORE >>

"A group of insurers challenged the [U.S. Preventive Services Task Force's] coverage mandates as invalid because its members were not constitutionally appointed as 'officers of the United States' under Article II's Appointments Clause.... The case is now before the Supreme Court, where MI has filed a brief supporting the challengers that explains the original meaning of superior and inferior officers for purposes of the Appointments Clause and overall political accountability." [Braidwood Mgmt, Inc. v. Becerra, No. 23-10326 (5th Cir. Jun. 21, 2024; cert. pet. granted Jan. 10, 2025)]  MORE >>

" 'Why would America's plan sponsors continue to offer retirement plans with generous company matches if the trial bar is going to turn these voluntary benefits into liability traps?' This question, which [EBSA nominee Daniel Aronowitz] asked in a blog from Sept. 2024, more or less summarizes his concerns with ERISA litigation, which he considers not just excessive but destructive.... Aronowitz ... suggests that fiduciary liability should be shifted away from sponsors and onto providers, especially in cases where the business model of that provider is an issue in the case."  MORE >>