"A major problem for employees determining to whom they want to offer benefits is the a wide variety of tests under different laws they must consider, many of which have overlapping elements.... The possible addition of new 'employees' to a company's payroll to eliminate confusion over multiple tests would have potentially far-ranging consequences ... Reclassification could affect company leave policies as well, including the need to cover more newly minted 'employees' under the federal Family and Medical Leave Act[.]"   MORE >>

"Plaintiff [contended] that the Court should enjoin Hartford's recovery of the overpayment on equitable grounds.... Facts supporting the Court's conclusion [included] ... a record that supports the finding that Plaintiff was informed of and understood or should have understood that he was being overpaid LTD benefits ... and Hartford's repeated effort to get accurate information and documentation from Plaintiff about his SSDI payments." [ Cutway v. Hartford Life & Accident Co. , No. 22-00113 (D. Me. Jan. 22, 2024)]   MORE >>

"Key areas of focus.... [1] ERISA preemption.... [2] Prescription drugs.... [3] Paid leaves.... [4] Telehealth.... [5] Insurance coverage mandates.... Key action steps ... [1] Engage with peers, trade groups.... [2] Leverage vendor relationships.... [3] Keep your superiors informed."   MORE >>

"As employers seek to utilize direct contracting and similar arrangements, 'a critical component … is use of transparent data on differences in provider price and quality,' [Christopher Whaley, health economist with the Rand Corporation,] said during the hearing. 'Unfortunately, several self-funded employers who want access to their plans' claim data for auditing or monitoring purposes have actually had to file lawsuits to gain access to this type of data.' "   MORE >>

"The House Education and Workforce Committee is seeking input from employers on policies that will strengthen and protect ERISA and the employer-sponsored health care system. The committee is requesting information on how to update and strengthen ERISA and the employer-sponsored system particularly related to industry changes around data sharing, AI, and specialty drugs."   MORE >>

"This article seeks to provide an overview and explore a few of the recent developments in the mental health parity domain and how such changes might shape the future of mental health care. [1] Finalization of the proposed regulations ... [2] Mental health care and Medicare ... [3] MHPAEA claims in the Tenth Circuit."   MORE >>

"Health reimbursement arrangements (HRAs), which can be offered in lieu of, or in combination with, an employer-sponsored medical plan, may be an attractive benefit depending on an employer's situations, including size and budget. More specifically, HRAs provide a way for employers to reimburse their employees for qualified medical expenses, including insurance premiums in some cases, on a tax-favored basis."   MORE >>

"[E]mployers must answer important questions to anticipate their immediate, short-term and long-term goals & objectives.... Focusing too intently on the implementation of wellness tactics at the beginning can distract from strategic goals and defining metrics. Once the strategic why, what and who are decided, then you can move on to the more tactical how, where and when."   MORE >>

"The Pennsylvania Insurance Department's Independent Review Program launched this month. It assigns eligible cases to teams of doctors, specialists and other experts who determine if an insurance denial was correctly or incorrectly issued.... The program will take cases submitted by residents who have health plans they purchased through Pennie, the state's [ACA] marketplace; people who buy their insurance directly from a company; and workers who get health plans through their employers."   MORE >>

"[T]he Innovation in Behavioral Health (IBH) Model [is] designed to improve outcomes for adults with mental health and substance use disorders (MH/SUD) by enhancing behavioral health provider capacity to integrate physical health care into their practice settings and services ... CMMI will provide infrastructure funding to providers that participate in Medicare, and the selected states will provide similar funding for Medicaid-only provider practices under aligned program requirements."   MORE >>

"[IRS announced] tax relief for individuals and businesses in parts of Rhode Island affected by severe storms, flooding and tornadoes that began on Sept. 10, 2023. These taxpayers now have until June 17, 2024, to file various federal individual and business tax returns and make tax payments.... [I]ndividuals and households that reside or have a business in Providence County, qualify for tax relief."   MORE >>

"The provider industry, particularly among retirement plan recordkeepers and self-funded health plan TPAs, has become very consolidated resulting in fewer alternative providers for sponsors to choose.... [T]his consolidation has enhanced the leverage of providers and caused 'market terms' to be dictated by the few. In addition, providers have become very adept at maximizing contract leverage via process."   MORE >>