Biden Announces Initiatives to Lower Health Care Costs

President Joe Biden recently announced initiatives to lower consumer healthcare costs and crack down on “junk” short-term insurance policies. The Biden administration plans to place significant limits on the short-term insurance policies that are supposed to provide temporary coverage as people transition between jobs but often deny basic health care coverage. The goal is to close existing loopholes that currently Read More

Supreme Court Decision Prompts CMS to Send $9B to 1,600 Hospitals for Medicare Underpayments

After a recent U.S. Supreme Court decision found that the U.S. Department of Health and Human Services (HHS) had wrongfully cut prescription drug prices for 349B-covered hospitals between 2018 and 2022, the Centers for Medicare and Medicaid Services (CMS) is proposing to return $9 billion in underpayments to those 1,600 hospitals. The 340B Drug Pricing Program requires drug companies to offer outpatient Read More

IRS Issues Guidance on COVID-19 Expenses for HDHPs and Clarifies HSA Rules on Preventive Care

Due to the end of the COVID-19 public health and national emergencies, the Internal Revenue Service (IRS) has issued guidance to high-deductible health plans (HDHPs) in the form of Notice 2023-37. This notice provides guidance on COVID-19 expenses for and clarifies items and services related to preventive care under health savings account (HSA) eligibility rules. Under its 2020 guidance, the IRS allowed HDHPs to Read More

Sixth Circuit Finds Benefits Committee Improperly Delegated Eligibility Determination, Penalizes ERISA Plan Administrator for Failure to Timely Provide Plan Documents

An ERISA-governed employee welfare benefit plan participant filed a request for extended long-term disability benefits. She received a denial of her request from the employer’s benefits department. The participant sued the plan and the plan administrator, arguing that she was entitled to extended benefits. She also claimed the plan failed to provide her with timely copies of the plan and other documents that she Read More

IRS Office of Chief Counsel Issues Memo Addressing Tax Treatment of Employer-Funded, Insured, Fixed-Indemnity Wellness Policy

The IRS Office of Chief Counsel recently issued Chief Counsel Advice (CCA) 202323006, which relates to the tax treatment of an employer-funded, insured, fixed-indemnity wellness policy. Although CCAs are not usable or citable as precedent, they provide insight into IRS policy and guidance for employers and wellness plan sponsors, particularly for audits. The policy the Chief Counsel addressed in the memo provided Read More

Bipartisan Telehealth Bill for Workers Moves Through Congress

The Telehealth Benefit Expansion for Workers Act of 2023 continues to move through Congress with bipartisan support. The bill supports continued access to telehealth services beyond the COVID-19 pandemic, allowing employers to offer standalone telehealth coverage for workers, including part-time, seasonal, and contract workers. The bill aims to increase access to mental health services, remedy provider shortages, Read More

Employer Advocacy Group Requests Guidance from IRS and Treasury on Implementing SECURE 2.0

The ERISA Industry Committee (ERIC), an employer advocacy group, has requested guidance from the Internal Revenue Service (IRS) and the U.S. Department of Treasury for implementing SECURE 2.0. In a recent letter, ERIC explained that the group was asking for guidance and regulations designed to increase efficiency, decrease burdensome plan administration, and ultimately, create better benefits for plan Read More

Fifth Circuit Grants Stay of ACA Preventive Health Services Mandate During Braidwood Appeal

The U.S. Court of Appeals for the Fifth Circuit has stayed the trial court’s ruling in Braidwood v. Becerra, pending appeal by the U.S. government, by the parties' agreement. Braidwood concerns the constitutionality of the preventive health services mandate of the Affordable Care Act (ACA). More specifically, the case addresses the legality of the insurance coverage required by the U.S. Preventive Services Task Force Read More

Ford Accuses Blue Cross of Price Fixing to Inflate Profits

Ford Motor Company has filed suit against Blue Cross Blue Shield, accusing the health insurer of conspiring to fix prices to reduce competition and violating antitrust laws. More specifically, Ford claims that the Blue Cross scheme to reduce competition between entities deprived it of the opportunity to purchase health insurance coverage from lower-cost competitors or at costs determined by the free market. As a Read More

Wake Forest Medical Center Settles ERISA Class Action Suit

Wake Forest University Baptist Medical Center has agreed to settle a proposed ERISA class action lawsuit pending in a North Carolina federal district court. In Garnick et al. v. Wake Forest University Baptist Medical Center et al., former employees claimed that plan administrators had violated their fiduciary duties under ERISA in administering the $2 billion retirement plan covering about 30,000 participants. The Read More