Federal Health & Welfare Updates

Oct 23, 2024

CMS Proposes 2026 Notice of Benefit and Payment Parameters Rule

On October 8, 2024, CMS released the proposed Notice of Benefit and Payment Parameters Rule for 2026. This notice is issued annually preceding the applicable benefit year and, once final, adopts certain changes. Additionally, CMS issued Premium Adjustment Percentage and related guidance to inform the payment parameters for the 2026 benefit year.

Oct 23, 2024

IRS Expands List of Preventive Care Benefits Permitted Under an HDHP

On October 17, 2024, the IRS published two notices (Notice 2024-71 and Notice 2024-75) to expand and clarify the list of preventive care benefits that are permitted under an HDHP without a deductible or with a deductible below the applicable minimum deductible for the HDHP.

Oct 23, 2024

Tenth Circuit Reviews Standing and Document Production for MHPAEA Claim

On October 1, 2024, in M.S., et al v. Premera Blue Cross, et al, the United States Court of Appeals for the Tenth Circuit (the Tenth Circuit) vacated a lower court’s MHPAEA violation judgment because the plaintiffs lacked standing to bring a MHPAEA claim against the defendants in federal court. 

Oct 23, 2024

Uncertainty Continues to Plague the NSA Arbitration Process

Currently, the Fifth Circuit Court of Appeals (Fifth Circuit) is considering an appeal by air ambulance providers Guardian Flight, LLC and Med-Trans Corporation (appellants) of a district court decision dismissing their claim against insurer Health Care Service Corporation (appellee).

Oct 10, 2024

Third Circuit Upholds Dismissal of ERISA Claims over Drug Rebates

On September 25, 2024, in Knudsen v. MetLife Group Inc., the Third Circuit Court of Appeals (Third Circuit) affirmed the dismissal of a putative class action lawsuit claiming ERISA violations by defendant MetLife for its retention of prescription drug plan rebates.

Oct 10, 2024

Tax-Advantaged Wellness Indemnity Arrangements Require Careful Review

Certain pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment (sometimes referred to as “wellness indemnity plans” or “FICA savings programs”) frequently lack a legitimate basis in tax law (the Internal Revenue Code (IRC)) and consequently are typically too good to be true. 

Oct 10, 2024

Fifth Circuit: Insurer’s Denial of Eating Disorder Benefits Violates ERISA

On September 19, 2024, in Dwyer v. United Healthcare Ins. Co., the United States Court of Appeals for the Fifth Circuit (the court) found that defendant United Healthcare (UHC) improperly denied benefits for the continuing treatment of a participant’s anorexia nervosa, disregarding both the plan’s own coverage terms and its claims and appeals procedures.

Sep 25, 2024

HHS Cybersecurity Newsletter Explains HIPAA Facility Access Control Requirements

HHS's Office for Civil Rights (OCR) has recently released its latest cybersecurity newsletter to remind HIPAA-covered entities, which include employer-sponsored health plans, and business associates (collectively, “regulated entities”), that physical security measures such as facility access controls are essential for HIPAA Security Rule compliance. These measures help prevent unauthorized access to electronic protected health information (ePHI) as the incidences of cyberattacks and breaches of ePHI are increasing.

Sep 25, 2024

Court: Denial of Wilderness Therapy Benefits Not Compliant with ERISA

On September 12, 2024, in Amy G. v. United Healthcare, the US District Court of Utah (the court) ruled that the denial of wilderness therapy benefits by defendants United Healthcare and United Behavioral Health (UBH) was arbitrary and capricious because UBH failed to provide a sufficient explanation and analysis for the denial, as required by ERISA. The court remanded the claim back to the defendants for reevaluation and redetermination.

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PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.

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