Insights

When the 2021 Consolidated Appropriations Act (CAA) was enacted just before the New Year, the far-reaching impact on employer-sponsored group health plans was unknown. As it turns out, the CAA requirements have impacted group health plans in many areas, including new cost transparency, surprise billing and pharmacy data reporting requirements. Deadlines for implementing cost transparency reporting and surprise billing have come and gone. The next hurdle on the CAA track is pharmacy data collect

To comply with Medicare Part D, an employer that sponsors a group health plan offering prescription drug coverage must satisfy two basic disclosure requirements. First, the plan must notify all Medicare Part D eligible individuals whether or not the prescription drug coverage is creditable, meaning it is expected to pay on average as much as the standard Medicare Part D coverage. The creditable status of the coverage can be determined through actuarial analysis or via the CMS Creditable Covera

On August 3, 2022, Gov. Carney signed HB 303 into law. The new law requires insurers to provide coverage for an annual behavioral health well check, which is defined as: 'A pre-deductible annual visit with a licensed mental health clinician with at minimum a masters level degree. The well check must include but is not limited to a review of medical history, evaluation of adverse childhood experiences, use of a group of developmentally appropriate mental health screening tools, and may includ

On September 16, 2022, the Office of Personnel Management, IRS, EBSA and HHS (the agencies) released a request for information regarding the transfer of data from providers and facilities to plans, issuers and carriers; other policy approaches; and the economic impacts of implementing these requirements. The request is part of a rulemaking process for the advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements of the No Surprises Act (NSA). Under the NSA, healthcare

On September 16, 2022, the DOL published an Initial Regulatory Flexibility Analysis (IRFA) on a proposed amendment to the qualified professional asset manager (QPAM) class prohibited transaction exemption, PTE 84-14. This exemption permits an investment fund managed by a QPAM to engage in certain party-in-interest transactions that would otherwise be prohibited by ERISA and the Code. As previously reported in Compliance Corner, the DOL recently proposed to amend several aspects of the QPAM

On September 23, 2022, the Office of Insurance Regulation issued a notice following Executive Order #22-218, in which Gov. DeSantis declared a state of emergency in 24 counties in the potential path of Hurricane Ian. The notice is directed at all health insurers, health maintenance organizations and other health entities authorized to do business in Florida. As background, Florida statutes permit early prescription refills if the governor issues an executive order declaring a state of emergenc

On August 15, 2022, the US Court of Appeals for the Fourth Circuit held in Roberts v. Gestamp West Virginia, LLC, that a jury must decide whether an employee's Facebook message to his supervisor satisfied the notice requirements under the Family and Medical Leave Act (FMLA). The employee underwent emergency surgery in 2019 and sent his supervisor a Facebook message indicating he would miss two weeks of work due to the surgery. The employee and his supervisor communicated via Facebook during hi

On September 23, 2022, Superintendent Toal released Bulletin No. 2022-017. The bulletin informs all health insurance plans regulated by the state that on August 4, 2022, HHS declared the monkeypox virus outbreak a national public health emergency. State law prohibits cost-sharing requirements related to testing or delivery of healthcare for any condition that is the subject of a declared public health emergency. Accordingly, the bulletin announces that no individuals shall be charged cost-shari

On September 6, 2022, the Department of Insurance issued Bulletin No. 2022-10 to announce the indexed increase in the annual maximum benefit for behavioral therapy coverage. The bulletin was directed at HMOs and carriers writing insurance in the state. State law requires that an annual adjustment of the maximum benefit for behavioral therapy coverage be made to reflect any change from the previous year in the Consumer Price Index. Accordingly, the department determined that the maximum benefit