
Health insurance has become a heavily regulated government utility managed by government bureaucrats in far away places. Every day we are reminded how busy they are.
Below are notices we received today. The volume of information is not unusual. We get as much or more every day. There are 12 shown below. Multiply 12 X 365. That’s a big number, so big it’s impossible to keep up. Yet we must if we are to properly advise our clients. Thank goodness for E&O coverage.
[Guidance Overview]HIPAA Final Rule Addressing Reproductive Health Requires Significant Compliance Measures by December 2024“Changes to [HIPAA] will require stakeholders across the health care industry to update their internal policies and procedures — and in some cases their business associate agreements — relating to the use or disclosure of protected health information (PHI) for specific purposes connected to reproductive health. The compliance date for implementing these new requirements under the HIPAA Final Rule to Support Reproductive Health Care Privacy is December 23, 2024. Notices of Privacy Practices (NPPs) must also be revised, and that compliance date is February 16, 2026.” MORE >>Frost Brown Todd LLC |
[Guidance Overview]The FTC’s Revised Health Breach Notification Rule Is Now in Effect“A new rule, which took effect this week, expands the scope of the HBNR, as the FTC ramps up enforcement activity related to disclosures of identifiable health data, and other agencies implement changes to the Health Insurance Portability and Accountability Act (HIPAA), Part 2, and Information Blocking rules regulating similar data.” MORE >>Ballard Spahr LLP |
[Guidance Overview]State Law Developments: Paid Leave, Prescription Drug Coverage, and Telehealth (PDF)18 pages. “Two states — Kentucky and South Carolina — added paid family leave as an optional form of insurance coverage. Idaho and Kentucky passed significant pharmacy benefit manager laws, which may impact self-funded ERISA plans. Prior authorization continued to be a focus in 2024; new Colorado, Oklahoma and Vermont laws restricted the practice for fully insured plans. Alabama will make a childcare tax credit available to employers over the next three years. Mississippi approved a plan to establish a state-based health insurance marketplace.” MORE >>Mercer |
[Guidance Overview]Minnesota Parenting and Parental Leave Act Amended“Effective August 1, 2024, the state Parenting and Parental Leave Act is amended to make clear that a person taking such leave must remain covered by their employer’s health plan while on the leave and that this leave must not be reduced by any period of paid or unpaid leave taken for prenatal care medical appointments” MORE >>NFP |
Loper Bright Leads to Section 1557 Stay“As cited in Judge Guirola’s decision, the preamble to the May 2024 Final Rule states that HHS ‘determined it is not necessary to define “sex” in this rule,’ presumably because it believed its interpretation of the underlying statute’s meaning was the end of the matter; however, as the plaintiffs noted — and the court repeated — the underlying statutory language … [does] not expressly include gender identity as a protected category.” [Texas v. Becerra, No. 24-0211 (E.D. Tex. July 3, 2024); Tennessee v. Becerra, No. 24-0161 (S.D. Miss. July 3, 2024)] MORE >>Husch Blackwell |
Eleventh Circuit Affirms FMLA Does Not Provide Pre-Birth Leave for Unmarried Fathers“In its ruling, the Eleventh Circuit wrote that the facts of this case were quite narrow as to whether FMLA provides ‘an expectant parent who is neither pregnant nor married to a pregnant spouse with pre-birth leave,’ to which the court affirmed the requested leave did not fall under FMLA protection.” [Tanner v. Stryker Corp. of Michigan, No. 22-14188 (11th Cir. Jun. 20, 2024)] MORE >>NFP |
Wells Fargo Faces Lawsuit Over Alleged Health Plan Mismanagement and Inflated Prescription Costs“The core of the Minnesota lawsuit revolves around claims that Wells Fargo’s health plan pays inflated prices to pharmacy benefit managers (PBMs)…. One striking example cited in the lawsuit involves the cancer medication bexarotene. Wells Fargo’s health plan allegedly paid over $69,000 for a tube of bexarotene, which could be purchased for as little as $3,750 at other pharmacies.” [Navarro v. Wells Fargo & Co., No. 24-3043 (D. Minn. complaint filed Jul. 30, 2024)] MORE >>Invezz |
Update on Outcomes Under the No Surprises Act Arbitration Process“The mean prices emerging from IDR were higher than the mean in-network prices paid before the NSA — and to a greater degree than in the first half of 2023…. Insurers’ offers were, on average, slightly above the qualifying payment amount (QPA), the median of the insurer’s contracted rates for the relevant service in 2019, adjusted for inflation. Providers submitted much higher offers, on average, and prevailed at least four-fifths of the time.” MORE >>The Brookings Institution |
Reminder: Massachusetts PFML Data Due by August 31, 2024“[T]he Department of Family and Medical Leave (DFML) announced its intention to require PFML private plans to furnish data for the period from July 1, 2023, through June 30, 2024. The submission form opened online on July 1, 2024, and the deadline for submission is August 31, 2024.” MORE >>NFP |
Benefits in General |
[Official Guidance]IRS Disaster Relief Notice KY-2024-03, for Victims in Kentucky“[I]ndividuals and businesses in Kentucky that were affected by severe storms, straight-line winds, tornadoes, landslides, and mudslides that began on May 21, 2024 … now have until Feb. 3, 2025, to file various federal individual and business tax returns and make tax payments…. [I]ndividuals and households that reside or have a business in Adair, Allen, Ballard, Barren, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Clay, Clinton, Crittenden, Cumberland, Edmonson, Estill, Fulton, Garrard, Graves, Grayson, Green, Greenup, Hart, Hickman, Hopkins, Jackson, Knox, Larue, Laurel, Lee, Leslie, Livingston, Logan, Lyon, Marshall, McCracken, McCreary, McLean, Meade, Menifee, Metcalfe, Monroe, Muhlenberg, Ohio, Owsley, Pulaski, Rockcastle, Russell, Simpson, Todd, Trigg, Warren, Washington, Wayne, Whitley, and Woodford counties qualify for tax relief.” MORE >>Internal Revenue Service [IRS] |
Employee Benefit and Employment Law Regs After Loper Bright“To the extent DOL conceived in its Fiduciary Rule 4.0 that it was appointed by Congress in ERISA to be a universal financial services regulator … for example, or the Federal Trade Commission conceived in its non-compete rule that Congress had authorized it to displace state law on that issue, the early returns from the courts hearing challenges to those regulations are pointing in the direction of a greater check on agency power.” [Loper Bright Enterprises, Inc. v. Raimondo, Sec. of Comm., No. 22-451 (S. Ct. Jun. 28, 2024)] MORE >>Eversheds Sutherland |
Supreme Court 2024 Rulings Usher in a New Era for Health Insurance and Retirement Benefits Regs“these rulings could affect how stakeholders view the significant rulemaking activities undertaken affecting coverage, including the annual notice of benefit and payment parameters … The recent Supreme Court decisions are also expected to significantly impact retirement plan operations and administration, particularly in terms of compliance, investment strategies, and participant outcomes.” [SEC v. Jarkesy, No. 22-859 (S. Ct. Jun. 27, 2024); Loper Bright Enterprises, Inc. v. Raimondo, Sec. of Comm., No. 22-451 (S. Ct. Jun. 28, 2024); Corner Post v. Bd. of Gov. of the Federal Reserve System, No. 22-1008 (S. Ct. Jul. 1, 2024)] MORE >>Milliman UPDATE: HERE ARE JUST A FEW WE RECEIVED EMAILS ON THE NEXT DAY: Minnesota Adopts New Rules for Parental Leave Starting August 1, 2024 “Minnesota’s new paid family and medical leave law will take effect on January 1, 2026. However, starting on August 1, 2024, pregnant workers can take prenatal medical leave without it counting against their twelve weeks of parental leave. Employers must offer the same health benefits during pregnancy and parental leave, contributing to the health benefits as if the employee were working.” MORE >> Ogletree Deakins Eighth Circuit Affirms Award of Long-Term Disability Benefits for Plaintiff Disabled from Sedentary Work “In affirming the decision of the district court, the Eighth Circuit noted that the standard of review is one for clear error. The district court cited ample evidence in the record showing that Plaintiff lacked sedentary-work capacity, including opinions of her treating physicians and Plaintiff’s favorable Social Security Disability Insurance determination.” [Weyer v. Reliance Standard Life Ins. Co., No. 23-2862 (8th Cir. Jul. 30, 2024)] MORE >> Roberts Disability Law Michigan Supreme Court Voids Current Paid Medical Leave Law and Reinstates 2018 Ballot Initiatives “The Michigan Supreme Court’s Opinion voids … the current Michigan Paid Medical Leave Act and reinstates … the Earned Sick Time Act as [it was] originally adopted by the Michigan Legislature in September 2018 … The Court’s Opinion also provides for a 205-day period of transition to allow employers to prepare for and comply with these new laws…. Michigan businesses will be required to begin complying with … the Earned Sick Time Act on February 21, 2025.” [Mothering Justice v. Attorney General, No. 165325 (Mich. Jul. 31, 2024)] MORE >> Miller Johnson The Business Impact of ERISA Excess Fee Litigation in Health Plans “How companies can mitigate risks [1] Regular fee benchmarking … [2] Prudent service provider selection and monitoring … [3] Transparent fee disclosures … [4] Fiduciary education … [5] Working with independent consultants.” MORE >> Forbes; subscription may be required Unforeseen Health Care Bills and Coverage Denials by U.S. Insurers “Forty-five percent of insured, working-age adults reported receiving a medical bill or being charged a copayment in the past year for a service they thought should have been free or covered by their insurance. Less than half of those reporting billing errors said they challenged them…. Nearly two of five respondents who challenged their bill said that it was ultimately reduced or eliminated by their insurer…. Nearly six of 10 adults who experienced a coverage denial said their care was delayed as a result.” MORE >> The Commonwealth Fund Michigan Employers: Major Changes to Sick Leave Effective February 2025 “Beginning on February 21, 2025, Michigan employers must provide paid sick leave to all of its employees, which under the ESTA means an individual engaged in service to an employer in the business of the employer. This definition will require providing sick leave to not only full-time employees, but also to part-time employees, temporary employees, and independent contractors.” [Mothering Justice v. Attorney General, No. 165325 (Mich. Jul. 31, 2024)] MORE >> FosterSwift Benefits in General [Guidance Overview] Employer Resources on Remote Working Rights, Trends (PDF) 57 pages. “Remote working poses challenges and considerations for employers when devising or adjusting their policies — these include defining remote work and eligibility criteria, hybrid working arrangements, employee engagement, performance, cybersecurity, health and safety, the right to disconnect, employees who want to relocate to a different country or state, and returning remote workers to the workplace post-pandemic. Recently, several jurisdictions have introduced remote-working legislative measures for after the pandemic that clarify employer and employee requirements, and others are expected to follow suit.” MORE >> Mercer |