"[T]he Departments intend to release schema version 2.0, which will implement revised technical requirements for the in-network file and out-of-network allowed amount and billed charges file.... [S]chema version 2.0 will reduce file size by requiring exclusion of duplicative data, reducing unnecessary data fields, and will include updates to better contextualize the data, making it more meaningful to ultimately achieve greater transparency."  MORE >>

25 pages. "The Departments request comments from all interested stakeholders to gain a better understanding of the issues related to compliance with, and implementation of, the prescription drug machine-readable file disclosure requirements ... The Departments are particularly interested in feedback related to prescription drug disclosure requirements on ... the required data elements, including potential additional or alternative data elements and other general implementation concerns."  MORE >>

May 22, 2025. "[H]ospitals must encode a standard charge dollar amount in the machine-readable file (MRF) if it can be calculated, including the amount negotiated for the item or service, the base rate negotiated for a service package, and a dollar amount if the standard charge is based on a percentage of a known fee schedule. Hospitals should discontinue encoding 999999999 (nine 9s) in the estimated allowed amount data element within the MRF and should instead encode an actual dollar amount."  MORE >>

"Questions for Public Comment: [1] Should CMS specifically define the terms 'accuracy of data' and 'completeness of data' in the context of HPT requirements, and, if yes, then how? [2] What are your concerns about the accuracy and completeness of the HPT MRF data? ... [3] Do concerns about accuracy and completeness of the MRF data affect your ability to use hospital pricing information effectively? ... [4] Are there external sources of information that may be leveraged to evaluate the accuracy and completeness of the data in the MRF? ... [5]What specific suggestions do you have for improving the HPT compliance and enforcement processes to ensure that the hospital pricing data is accurate, complete, and meaningful?"  MORE >>

"The departments jointly issued a Request for Information seeking public input ... regarding the prescription drug price disclosure requirements, including information ... such as the ability of health plans to access necessary data for reporting ... The agencies also released updated guidance [FAQs Part 70] ... that sets a clear applicability date for publishing an enhanced technical format for disclosures.... Separately, [CMS] released new guidance ... requiring hospitals to post the actual prices of items and services, not estimates. CMS also issued its own RFI to gather public feedback on how to boost hospital compliance and enforcement and ensure data shared is accurate and complete."  MORE >>

"[T]he purpose of the comparative analysis is to provide further visibility into whether plans are compliant with MHPAEA. Whether the analysis is determined to be sufficient or not, if an agency audit determines that any financial requirements or treatment limitations do not comply with the parity requirements, the plan may be required to take corrective action (e.g., reprocess claims and refund participants when applicable). In addition, non-compliant plans could be subject to a penalty[.]"  MORE >>

"A lawsuit accusing Blue Cross Blue Shield of Michigan of overpaying medical providers and participating in self-dealing, which had been dismissed by a district court, was remanded [by the Sixth Circuit] ... [The] court found that under the plan's administrative services contract, it allowed BCBSM to retain savings from payments it 'erroneously approved.' When an administrator can recover overpayments it 'unilaterally caused or controlled,' the court argued that constitutes discretion over compensation, affirming that BCBSM acted as an ERISA fiduciary[.]" [Tiara Yachts, Inc. v. Blue Cross Blue Shield of Mich., No. 24-1223 (6th Cir. May 21, 2025)]  MORE >>

"A federal district court in Virginia has denied an employer's motion to dismiss litigation brought by wellness program participants challenging tobacco surcharges imposed under the program.... [T]he district court cited an April 2025 ruling in which another [Virginia] district court held that plaintiffs had standing to challenge premium surcharges under a wellness program and adequately alleged that a wellness program's tobacco surcharges violated fiduciary standards of conduct under [ERISA]." [Bokma v. Performance Food Grp., Inc., No. 24-0686 (E.D. Va. May 20, 2025)  MORE >>

"The House Bill will have an impact that employers should note regarding [1] the administration of compliant health savings account (HSA) benefit programs, [2] changes to the health benefit exchanges under the [ACA] that could impact employer-provided medical insurance benefits, and [3] new restrictions on enforcement of Employee Retention Credit (ERC) claims."  MORE >>

"This blog is a practical guide for HR leaders navigating qualifying life events (QLEs) in employee benefits. It explains which life changes allow mid-year benefit updates, highlights common pitfalls -- like missed newborn enrollment windows -- and emphasizes the importance of aligning employer policies with carrier rules to maintain compliance under IRS Section 125."  MORE >>

"The exhibits in this brief illustrate how health care use and spending vary by age group ... They illustrate that people enrolled in ESI aged 55-64 use more services than all other adult age groups across all service categories. Per person spending also is higher for this age group than all other adults."  MORE >>

"The Association Health Plans Act of 2025 [S 1847] amends the Employee Retirement Income Security Act (ERISA) to give small business employees, sole proprietors, and gig workers the ability to aggregate together and access health insurance through large-group Association Health Plans (AHPs).... The bill requires participating associations to have existed for at least two years and to serve a broader purpose than providing health benefits"  MORE >>