On August 21, 2023, the Ninth Circuit vacated its prior decision and issued a new opinion in a complicated class action lawsuit against United Behavioral Health (UBH, a subsidiary of Optum, a division of UnitedHealth Group). The case, which began in 2016, was sent back to the trial court for the second time.

On August 29, 2023, in Bryant v. Walgreen Co., a federal district court dismissed most of the claims against a group health plan sponsored by Walgreens Co. (Walgreens), most notably the plaintiffs’ claim that Walgreens failed to adequately notify them of their right to continue health coverage as required by the COBRA statute.

On August 28, 2023, the DOL announced a grace period for users to obtain new login credentials for its EFAST2 filing system, which is used to file Form 5500 series annual returns. Beginning January 1, 2024, users will have to log in via the new Login.gov process instead of using existing EFAST2 credentials. Login.gov allows users to securely log in to many government agency websites using a single username and password.

On August 15, 2023, in David P. v. United Healthcare Ins. Co., the Tenth Circuit Court of Appeals (Tenth Circuit) reversed the defendant group health plan’s claim denial because the court determined that the defendant claims administrator abused their discretion and failed to follow ERISA claims procedures. The case was remanded with instructions to the district court to determine the appropriate disposition of the plaintiffs’ claims.

The DOL recently issued a guide to help health plan enrollees understand their mental health and substance use disorder benefits and rights under the Mental Health Parity and Addiction Equity Act (MHPAEA). The goal of MHPAEA is to ensure that people seeking coverage for mental health and substance use disorders can access treatment as easily as people seeking coverage for medical treatments.

On August 15, 2023, in PCMA v. Mulready, the Tenth Circuit Court of Appeals (Tenth Circuit) held that Oklahoma's Patient's Right to Pharmacy Choice Act (the Act) is preempted by ERISA, reversing a ruling by the US Western District Court of Oklahoma. The case was remanded with instructions to the district court to enter judgment consistent with the Tenth Circuit’s opinion.

On September 19, 2023, the DOL, HHS, and IRS (the departments) extended the comment period for the MHPAEA Proposed Rules and Technical Release announced on July 25, 2023. Please see our summaries of the Proposed Rules and Technical Release in the August 1, 2023, Compliance Corner edition.

On August 9, 2023, the Congressional Research Service (CRS) issued the Medicare Secondary Payer (MSP) Coordination of Benefits report. The CRS serves Congress in the legislative process by providing policy and legal analysis to committees and members of both the House and Senate, regardless of party affiliation. This report reviews the MSP system, reporting requirements, Medicare beneficiary responsibility, payer liability issues...

On August 11, 2023, the DOL, HHS, and IRS (“the agencies”) issued FAQs regarding administrative fees charged to group health plans, insurers, and out-of-network providers involved in payment disputes subject to the independent dispute resolution (IDR) provisions of the No Surprises Act (NSA).

Recently, HHS issued the first in a series of five annual reports to Congress on the impact of the No Surprises Act (NSA). The NSA was enacted in 2020 to address certain instances of surprise billing, where individuals receive unexpectedly high medical bills after receiving treatment, either unknowingly or unavoidably, by an out-of-network (OON) provider, facility, or provider of air ambulance services subject to NSA requirements.