"The PWFA applies only to 'covered employers' which is defined as private and public sector employers with at least 15 employees, Congress, Federal agencies, employment agencies, and labor organizations. The PWFA requires employers to provide reasonable accommodations to a worker's known limitations, meaning that the employee has communicated with the employer, related to pregnancy, childbirth, or related medical conditions."   MORE >>

"Maine’s program, which will provide up to 12 weeks of paid leave per year, covers all eligible employees of private and public employers, except employees of the federal government, in the state regardless of employer size. Employers and employees will split a 1% payroll tax to fund the paid family and medical leave program."   MORE >>

"Most (58%) people with health insurance say they encountered at least one problem using their coverage in the past year, with even larger shares of people with the greatest health care needs reporting such problem ... At least half within each of four major types of health coverage -- employer, Medicaid, the [ACA's] marketplace, and Medicare -- say they had a problem using their coverage in the past year."   MORE >>

"At a time when employee benefits, including health care, are a top priority for employees and employers alike, restricting health care in any area is problematic for employers. In addition to affecting companies in states that restrict abortion, large companies with operations in different states are also affected."   MORE >>

"Health insurers and medical providers are battling over who should supply high-cost infusion drugs for patients, with the tussle over profits now spilling into statehouses across the country. ... [S]ome insurers are bypassing hospital pharmacies and physician offices and instead sending more complex drugs through third-party pharmacies. Those pharmacies then send the medications directly to the medical provider or facility for outpatient infusing ... That shifts who gets to buy and bill for these complex medications, including pricey chemotherapy drugs."   MORE >>

"For anyone familiar with retirement communities, the rise in the popularity of pickleball is nothing new.... The growing popularity of the game is expected to result in $377M in medical injuries this year (UBS analysis).... Since the game is widely enjoyed among seniors, most injuries occur in those over 60-years-old, and Medicare has had to deal with a disproportionate amount of the costs so far. However, as the game draws in younger players, private health plans are expected to see more direct costs from the sport."   MORE >>

"While specific paid leave statutes related to COVID are sunsetting, lawmakers in at least 44 states have introduced more than 300 measures related to the issue since the beginning of 2023, reflecting the fact that paid leave as a policy issue had momentum with lawmakers even before the pandemic."   MORE >>

"Inefficiencies in the PA process can lead to overutilization of healthcare services as well as patient delays in receiving necessary services ... Several reforms and initiatives have been undertaken to improve the PA process.... To enhance PA, plan sponsors can consider the following steps:"   MORE >>

"Though this Court has sometimes allowed contract-based claims to survive ERISA's broad preemption provision, Plaintiff's breach of contract and promissory estoppel claims are different because they seek to establish an enforceable contractual obligation merely because Cigna engaged in routine activities critical to the administration of an ERISA health benefit plan -- namely, preauthorizing healthcare services and verifying the terms of coverage." [ Bristol SL Holdings, Inc. v. Cigna Health and Life Ins. Co. , No. 19-0709 (C.D. Cal ; on appeal to 9th Cir. No. 23-55019)]   MORE >>

"While value-based purchasing (VBP) programs have proliferated in the past two decades, quality measures have become increasingly important as they are employed to calculate the 'value' of care.... CMS recently announced a new strategy, the Universal Foundation, to scale back to a core set of just about twenty quality measures and align them across programs.... The central question is: What is the most crucial aspect of 'value' of care that we can measure for value-based arrangements without needing an excessive number of quality measures or risking too few?"   MORE >>