Employee Benefits Archives - Page 13 of 142

Discerning Congressional Purpose from the Proposed MHPAEA Regulations Comment Letters

by Alden Bianchi | Nov 8, 2023 | Employee Benefits, Health and Welfare Plans, Mental Health Parity and Addiction Equity Act

We continue our investigation of proposed regulations under the Mental Health Parity and Addiction Equity Act (MHPAEA) issued by the US Departments of Labor, Health and Human Services and the Treasury (the Departments). Our previous MHPAEA content is available here.

The comment period for the proposed regulations closed on October 17, 2023, and one thing is clear: Stakeholders are divided not so much over particulars of the proposal but rather on the broad scope and reach of the rule. The is no doubt that the rule is intended to enact an overarching policy goal of the Biden administration. One need look no further than the administration’s July 25, 2023, fact sheet, which touts the administration’s “comprehensive national strategy to transform how mental health is understood, accessed, treated, and integrated in and out of health care settings.” Nor is there any doubt that the proposed rule is granular and prescriptive, as we previously explained.

While many of the comment letters address the particulars of the rule, certain high-profile comments ask whether it should be adopted at all. On one side are the providers (see the American Hospital Association’s comments, which offer a full-throated endorsement of the rule); on the other are the carriers (see AHIP’s comments, which claim the rule is vague and impossible to administer and calls for its withdrawal.)

If the final rule looks anything like the proposal, there will be a challenge, the particulars of which will likely include one central question: Is the final rule consistent with Congress’ intent in the matter? Dueling comments by the majority and minority members of the House of Representatives Committee on Education and the Workforce and (in the case of the minority) the Subcommittee on Health, Employment, Labor, and Pensions frame the question as follows:

Comment letter of Virginia Foxx, Chairwoman, Committee on Education and the Workforce

Citing MHPAEA’s legislative history, the majority claims that “Congress did not intend to include NQTLs [nonquantitative treatment limitations] when enacting the MHPAEA.” According to the comment letter, “the [MHPAEA] Committee report does not contain one mention of an NQTL.” (While the letter refers to the “Consolidated Appropriations Act, 2021 (CAA),” it does not attach any significance to that law’s requirement for plans and issuers to prepare and furnish on-demand reports detailing their NQTL compliance.) The majority also expresses its view that measuring and analyzing outcomes data is both impractical and exceeds the scope of the law. The majority is perplexed that the Departments believe they have the authority “to require plans to measure outcomes data stems from the statutory language.”

Comment letter of Bobby Scott, Ranking Member, Committee on Education and the Workforce, and Mark DeSaulnier, Ranking Member, Subcommittee on Health, Employment, Labor, and Pensions.

The minority’s comments welcome the proposed rules’ “emphasis on access to behavioral health care” and make the claim that the imposition of rules governing NQTLs is “entirely consistent with the statutory [...]

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Employer Due Diligence Lessons from UK Share Scheme Case

by Katie Clark, Paul McGrath and Charlotte Moorhouse | Nov 7, 2023 | Employee Benefits, Employment

The recent decision in Ponticelli Limited v Gallagher provides a salient reminder that the right to participate in a share incentive plan can transfer to a new employer under the Transfer of Undertakings (Protection of Employment) Regulations. The right applies even if the employee’s right to participate in the plan arose outside of the contract of employment. The employee will be treated as a leaver under their old employer/transferor’s scheme, and the transferee employer must then provide a scheme of substantial equivalence for the employee to participate in post-transfer.

While this is a Scottish case, the decision is binding on the employment tribunals throughout the UK.

Read more here.

HHS Proposes Updates to Disability Nondiscrimination Regulations for First Time in Nearly 50 Years

by Gregory Fosheim | Nov 2, 2023 | Employee Benefits, Health and Welfare Plans

Discrimination on the basis of disability has contributed to significant disparities in healthcare and child welfare. To address these disparities, the US Department of Health and Human Services (HHS) recently proposed updated regulations implementing Section 504 of the Rehabilitation Act of 1973 to prohibit discrimination on the basis of disability in programs or activities that receive HHS funds. Although most of the revisions align with expectations imposed on stakeholders through other federal laws, some proposed changes are unique to HHS programs, including regulations impacting medical treatment, value assessments, medical diagnostic equipment, digital media and child welfare programs.

Access full article.

IRS Announces 2024 Employee Benefit Plan Limits

by Jeffrey Holdvogt, Jacob Mattinson and Brian Tiemann | Nov 1, 2023 | Employee Benefits, Fiduciary and Investment Issues, Retirement Plans

The Internal Revenue Service recently announced the cost-of-living adjustments to the applicable dollar limits for various employer-sponsored retirement and welfare plans for 2024. Certain health and welfare plan limits have not yet been released.

Most of the dollar limits that are subject to adjustment for cost-of-living increases will increase for 2024. The Social Security Administration released separate adjustment amounts.

See the limits here.

Opportunity Knocks: At Long Last, IRS Determination Letter Program Is Open for 403(b) Plans

by Todd Solomon and Jeffrey Holdvogt | Nov 1, 2023 | Employee Benefits, Retirement Plans

The Internal Revenue Service (IRS) recently opened a new determination letter approval program for 403(b) retirement plans—commonly used by nonprofit organizations—which allows sponsors of certain individually designed plans to apply for a favorable determination letter. Long available to 401(k) retirement plan sponsors, determination letters can provide sponsors with advance assurance from the IRS that plans are compliant with the Internal Revenue Code. Plan sponsors of eligible 403(b) programs should take advantage of this new opportunity to submit a determination letter application to the IRS.

Read more here.

CMS Announces New GUIDE Model to Support People Living with Dementia and Their Caregivers

by Gregory Mitchell, Fabiola Díaz Vera and Casey Li | Oct 31, 2023 | Employee Benefits, Health and Welfare Plans

To support people living with dementia and their unpaid caregivers, the US Centers for Medicare & Medicaid Services recently announced the Guiding an Improved Dementia Experience (GUIDE) Model, a new, voluntary and nationwide test model designed specifically for these two rapidly growing demographic groups. The model will offer care coordination and care management for individuals living with dementia and provide education, support and respite services for their caregivers.

The GUIDE model will launch on July 1, 2024.

Read more here.

DEA Further Extends Flexibilities for Controlled-Substance Prescribing via Telemedicine

by Amanda Enyeart, Marshall E. Jackson, Jr., Lisa Schmitz Mazur, Dale C. Van Demark, Patrick Zanayed, Purnima Boominathan, Grayson I. Dimick, Jayda Greco and Rachel Stauffer | Oct 25, 2023 | Employee Benefits, Health and Welfare Plans

The US Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration have further extended flexibilities that allow providers to prescribe controlled substances via telemedicine without first performing an in-person visit. The flexibilities were initially provided during the COVID-19 public health emergency. The extension runs through December 31, 2024.

Read more here.

States’ Rights, Trans Protections Collide at Fourth Circuit

by Sarah Raaii | Oct 24, 2023 | Employee Benefits, Health and Welfare Plans

The US Circuit Court of Appeals for the Fourth Circuit recently heard two cases from North Carolina and West Virginia state-run health plans that challenge lower court decisions on coverage exclusions for gender dysphoria treatments. According to this Law360 article, the cases could determine how much health plans can restrict access to gender-affirming care. McDermott Partner Sarah Raaii said employers are investigating how to preserve gender-affirming care access in places where it might no longer be accessible.

“I think a lot of the conversation is also coming back to travel benefits,” Raaii said.

Read more here.

States Move to Regulate Telehealth-Related Youth Services

by Stacey Callaghan and Abby Higgins | Oct 19, 2023 | Digital Health, Employee Benefits, Health and Welfare Plans

Numerous states—including Louisiana, Ohio, California, Tennessee and New Jersey—have been finalizing rulemaking and legislation that create or amend professional practice standards to incorporate telehealth. Several of these states have also proposed regulations or laws related to the provision of care to youths.

Read more here.

Pharmacy Benefit Manager Reform: What’s on the Horizon?

by Rachel Stauffer, Katie Waldo, Amy Kelbick, Leigh Feldman and Erica Stocker | Oct 17, 2023 | Employee Benefits, Health and Welfare Plans

The price of prescription drugs has brought scrutiny to the entire drug supply chain. Congress and other policymakers continue to seek opportunities to lower costs for patients and the federal government.

Pharmacy benefit managers (PBMs) are a key stakeholder in the drug supply chain, functioning as intermediaries between insurance providers and pharmaceutical manufacturers. PBMs administer prescription drug benefits and seek discounts for insurers as standalone plans, such as Medicare Part D plans, or as entities embedded in commercial insurance products, including Medicare Advantage, Medicaid Managed Care Organizations and employer-sponsored coverage.

PBMs are under increased scrutiny from policymakers due to the perceived opaqueness of their operations and their perceived role in increasing drug costs. As part of this scrutiny, Congress and other stakeholders are raising questions about PBMs’ impact on drug prices and out-of-pocket costs for patients. In the 118th Congress, several key committees have advanced legislation that would increase PBM transparency and reporting obligations and modify other business practices.

Read on for a side-by-side comparison of US House and US Senate PBM bills and our forecast of the possible effects of these proposed changes to PBM operations.