"[T]he Departments have determined that a process for reopening disputes to correct errors identified after dispute closure is needed to support disputing parties and certified IDR entities, and to ensure program integrity. This TA provides guidance to disputing parties and certified IDR entities on the error correction process and clarifies how certified IDR entities should treat three categories of errors identified after dispute closure."  MORE >>

"[T]he 2025 EO resembles a 2020 MFN drug pricing executive order ... which also directed the HHS Secretary to implement MFN pricing, but which was limited in application to Medicare Part B. This Legal Sidebar ... analyzes selected legal issues related to the HHS Secretary's authority to implement MFN pricing as directed in the 2025 EO.... [It] also explores the HHS Secretary's authority to impose MFN pricing for drugs in federal health care programs ... as well as in private markets. The Sidebar concludes with an analysis of how the MFN prices might interact with other existing federal programs[.]" [LSB11319, Jun. 5, 2025]  MORE >>

"If signed by the Governor, this bill would eliminate the one-hour increment minimum for [certain] employees of boards of education and municipalities if those employees are covered by a collective bargaining agreement ... [M]unicipalities and boards of education will be permitted to limit the use of the paid sick leave to the minimum increment prescribed in the collective bargaining agreement."  MORE >>

"In a case involving a health plan's denial of residential mental health treatment benefits for a participant's child as medically unnecessary, the Ninth Circuit has underscored the importance of clear delegation of authority and adequate denial notices in ERISA health claims and appeals." [Dan C. v. Directors Guild of Am. -- Producer Health Plan, No. 24-3203 (9th Cir. Jun. 3, 2025)]  MORE >>

"[T]he lawsuits have commenced following the enactment of the Arkansas legislation prohibiting pharmacy benefit managers (PBMs) from owning or operating actual pharmacies within the state. Michigan has filed its own lawsuit against PBMs. Further, a similar bill targeting PBMs is winding its way through the Illinois legislature."  MORE >>

"Denials of coverage by health plans, already a problem in 2023, increased during 2024 ... Overall initial denial of coverage rates climbed to 11.81% of claims in 2024 from 11.53% the previous year. That increase in initial denials came despite a drop in authorization-related denials to 1.52% of claims in 2024 from 1.64% in 2023.... [C]ollection rates from patients covered by managed care/commercial insurance [fell] to 34.46% from 37.58% a year earlier."  MORE >>

"[1] Increased monetary penalties for hospitals and health care payers ... [2] Increased audits ... [3] Attestation of compliance .. [4] Standardization of the MRFs ... [5] Making uniform the 'negotiated rates' in the hospital and TIC MRFs."  MORE >>

"[T]he US spends $13 432 per person on health care, nearly double what most comparable countries spend on average ... The U.S. spends more than other countries on health care not because U.S. individuals use more care, but rather because of higher prices. Higher U.S. health care prices are primarily driven not by public programs like Medicare or Medicaid, but rather by the commercial insurance sector."  MORE >>

"[H]igher-income households are more likely to pay for medical expenses out-of-pocket while letting their HSA balances grow tax-free -- essentially turning the HSA into a tax-advantaged investment or retirement vehicle. This can provide larger tax benefits in the long run than using HSA funds for medical care. In contrast, lower-income households are more likely to use HSA funds as they are deposited, missing the long-term tax advantage by treating the HSA more like a Flexible Savings Account."  MORE >>

"[1] What is old is new: get your health plan governance in order ... [2] Stay calm and carry on: mental health parity non-enforcement policy pauses only certain requirements ... [3] To report or not to report, that is the question: Florida data request to self-insured plans under pharmacy benefits management law ... [4] If you didn't document it, it didn't happen: takeaways from Cunningham v. Cornell university ... [5] How well is your wellness plan?"   MORE >>

"Aronowitz outlined a robust agenda that he said would improve EBSA's enforcement of fiduciary law, provide regulatory clarity, and champion the cause of encouraging plan sponsors to expand retirement and health care benefits to America's workers."  MORE >>

" 'EBSA needs a major turnaround, and I am an experienced turnaround manager with unique fiduciary expertise and experience,' Aronowitz said in a June 5 confirmation hearing before the Senate Health, Education Labor and Pensions Committee. 'If I am confirmed by the Senate, I will work hard to unleash and unlock the creativity and full potential of America's employee benefits system,' he added. 'But none of this will happen until we improve EBSA's enforcement and provide regulatory clarity on key fiduciary issues.' "  MORE >>