On July 25, 2023, the Third Circuit Court of Appeals (the Third Circuit) affirmed an award of damages for retaliation by the United States District Court for the Western District of Pennsylvania. One of the plaintiff’s claims was based on ERISA Section 510, which makes it unlawful to discharge a participant or beneficiary for exercising a right under an employee benefit plan or for the purpose of interfering with the attainment of any right under the plan.

On July 25, 2023, the DOL and CMS released the 2022 MHPAEA Enforcement Fact Sheet. The fact sheet, which is provided annually, summarizes enforcement data and results from MHPAEA investigations closed by the DOL and CMS in the prior fiscal year.

On July 25, 2023, the DOL, Department of the Treasury, and HHS (the departments) released the 2023 MHPAEA Comparative Analysis Report to Congress (“the 2023 Report”). The 2023 Report highlights the departments’ enforcement efforts regarding MHPAEA’s non-quantitative treatment limitations (NQTLs) (e.g., prior authorization and benefits exclusions) during the second year of the Consolidated Appropriations Act, 2021 (CAA, 2021)...

On July 25, 2023, the DOL issued a technical release accompanying the MHPAEA proposed rules (Please see our article entitled Departments Announce Proposed Rules to Strengthen MHPAEA, also featured in this edition of Compliance Corner.)

On July 25, 2023, the DOL, HHS, and IRS (the departments) announced proposed rules under MHPAEA aimed at ensuring that people seeking coverage for mental health and substance use disorders can access treatment as easily as people seeking coverage for medical treatments.

On June 7, 2023, the Eighth Circuit Court of Appeals affirmed the district court’s denial of a bariatric surgery patient’s claims. The ruling was based upon the plan’s exclusion of claims for weight loss procedures and related complications.

On June 14, 2023, the CMS launched a dedicated website with resources and customer service information to educate patients, providers and insurers about the No Surprises Act surprise billing rules that protect patients from unexpected out-of-network medical bills.

On July 7, 2023, the DOL, HHS and Treasury (collectively, the departments) released new FAQs (Part 60) addressing the coordination between the No Surprises Act (NSA) and the ACA annual out-of-pocket (OOP) maximum limit. The FAQs also address the interaction between the NSA and the ACA Transparency in Coverage (TiC) rules with respect to facility fees, which are increasingly charged for services provided even outside of hospital settings. Below is a key summary:

On June 8, 2023, the Eleventh Circuit affirmed a trial court's ruling that denying certain employment benefits to police officers on military leave while providing the same benefits to other employees on nonmilitary paid administrative leave violates the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA).

On May 30, 2023, the DOL issued an opinion letter that affirms its prior guidance regarding how to calculate the amount of FMLA leave entitlement when a workweek includes a holiday. “Workweek” is defined under the FMLA as the employee’s normal schedule (hours/days per week) prior to the start of FMLA leave.