23 pages; rev. Jun. 23, 2025. "[CMS is] revising the Final 2026 AV Calculator ... to accommodate potential new de minimis ranges and a potentially updated MOOP limit. The only changes ... are the following: [1] The de minimis range for bronze, silver, gold and platinum plans was expanded ... [2] The MOOP limit was updated to $10,600 ... These changes do not affect the AV calculation methodology.... the Revised Final 2026 AV Calculator does not affect any 2025 plans, and will only be applicable for 2026 plans." [Also available: Revised Final 2026 Actuarial Value Calculator (XLSM)]  MORE >>

"Although many plan obligations are tied either to the calendar year or the plan year, there are two [ACA] items that arise annually during the summer months: the Patient-Centered Outcome Research Institute (PCORI) Fee and Medical Loss Ratio (MLR) rebates."  MORE >>

"The new measure will go into effect on January 1, 2026, and increases the number of hours of paid sick leave employers must provide. Employers with 15+ workers will soon be required to provide employees with 72 hours of paid sick leave and employers with fewer than 15 employees will be required to provide 48 hours of paid sick leave."  MORE >>

"Employers with health plans currently covering gender-affirming care for minors may want to consider the following next steps: [1] Work with health plan partners to identify what services are covered. [2] Assess the impact these state laws have on plan members accessing gender-affirming care. [3] Consider plan member communications regarding coverage, navigators, and claim administration assistance. [4] Highlight available mental health benefits and/or EAPs. [5] Review plan medical travel benefits for sufficiency for plan members needing to travel frequently and far to access ongoing care." [U.S. v. Skrmetti, No. 23-477 (S.Ct. Jun. 18, 2025)]   MORE >>

"[E]mployers will want to revise their policies and procedures ... and inform certain employees (who handle PHI and that were trained on the new rule) that the 2024 Final Rule has been vacated.... [E]mployers who [already] incorporated the vacated rule in their [Notice of Privacy Practices (NPP)] ... should aim to revise (and provide) their NPP by Aug. 17, 2025, to remove the references to the vacated regulation." [Purl v. HHS, No. 24-0228 (N.D. Tex. Jun. 18, 2025)]  MORE >>

"While the Reproductive Health Privacy Rule did not expressly require updates to BAAs, some HIPAA-regulated entities revised or amended agreements to address specific requirements related to reproductive health information. These BAAs may need to be revised yet again in light of the current state of the HIPAA Privacy Rule." [Purl v. HHS, No. 24-0228 (N.D. Tex. Jun. 18, 2025)]  MORE >>

"The lawsuit ... contends that the law, Senate File 383, would upend prescription drug coverage in the state and violate the First Amendment by preventing employers from directing workers to some pharmacies over others. The lawsuit also says the Iowa law is in conflict with [ERISA]." [Iowa Association of Business and Industry v. Ommen, No. 25-0211 (S.D. Iowa complaint filed Jun. 23, 2025)]  MORE >>

"In a roundtable discussion hosted by HHS, health insurers pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers. Their commitments reinforce the role of CMS in monitoring outcomes and promoting accountability."  MORE >>

"The reforms are a voluntary initiative by the health plan industry, not a regulatory push by CMS. True enforcement thus will be limited, at least barring future regulations.... CMS will monitor progress, publish data on plan participation and enforce rules to the degree it is authorized to do so if plans do not meet their stated obligations.... The metrics will be published by AHIP and also will be available through CMS."  MORE >>

"While IDR entities are not identified in the [CMS public use files, the authors] developed a method to identify the IDR entities, [and] report here on their dispute volumes, determinations in favor of providers, and days to determination. As relevant, [they] also include observations from semi-structured conversations with stakeholders involved in the IDR process."  MORE >>

"Capping the individual exclusion from income for employer-sponsored coverage or capping employers' ability to deduct the cost of coverage as a business expense would be highly disruptive to employment-based coverage -- the single largest source of coverage in our nation.... Not only is the idea of taxing health benefits widely unpopular with Americans with this type of coverage, but there also are drastic economic and health-related consequences associated with capping the income and payroll tax exclusion of employment- based insurance."  MORE >>

"SCOTUS ruled that retirees who do not hold or seek employment at the time of the alleged discrimination are not protected under Title I of the ADA. The decision does not necessarily preclude all claims from retirees or all claims about retirement benefits. An ADA plaintiff must plead and prove that at the time of the alleged discrimination, they held or desired a job and could perform its essential functions with or without reasonable accommodation." [Stanley v. City of Sanford, FL, No. 23-997 (S. Ct. Jun. 20, 2025)]   MORE >>

"As a plan sponsor, taking steps to secure your plan data isn't optional, it's part of your legal duty to act in your participants' best interests.... [1] Review your vendor contracts for cybersecurity language. [2] Request and review audit reports from your service providers. [3] Implement basic security practices for your internal team. [4] Educate your participants about protecting their accounts. [5] Document your efforts as part of fiduciary oversight."  MORE >>