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McDermott Submits Amicus Brief to the US Supreme Court in United Behavioral Health

On January 2, 2024, McDermott filed an amicus curiae brief on behalf of the ERISA Industry Committee (ERIC) and the United States Chamber of Commerce (Chamber) in United Behavioral Health v. David K., No. 23-586, in the US Supreme Court. The case presents two questions of broad public importance concerning the requirements under the Employee Retirement Income Security Act (ERISA) for denials of health benefits. But underlying the two questions is an even more fundamental Administrative Procedure Act (APA) issue: May a court, at the invitation of an agency in an amicus brief, effectively amend regulations by judicial fiat, providing the agency with an end run around the APA’s notice-and-comment rulemaking procedures?

The answer to that question should be an obvious no. But that is precisely what happened in the court of appeals in this case. After the plaintiffs filed their response brief, the US Department of Labor (DOL) filed an amicus brief urging a radically new interpretation of regulations the agency had promulgated to implement ERISA’s procedural protections. In essence, the DOL argued that its disability- and health-benefit regulations should be read to contain the same procedural requirements, despite clear regulatory language specifying that some requirements only apply in one context and not the other. The US Court of Appeals for the Tenth Circuit adopted the DOL’s position, decreeing a new regulatory requirement for health-benefit denials that the DOL, in dual 2015 and 2016 rulemakings, expressly considered and chose to adopt only for disability-benefit denials and not for health-benefit denials.

If not corrected by the Supreme Court, the decision will stand as an invitation to agencies to file amicus briefs in the courts of appeals, advocating for substantial changes to their regulations without the bother (or transparency) of APA rulemaking. When so much lawmaking today is undertaken by unaccountable federal bureaucrats, that is a deeply troubling prospect. ERIC and the Chamber supported the petition, explaining the legal and practical issues with the approach the DOL and Tenth Circuit mutually took. Agency interpretations that defy clear regulatory text are entitled to no deference because they are invalid (especially after the Court’s decision in Kisor v. Wilkie). Ignoring this basic proposition of administrative law undercuts the core values served by the APA, including transparency and accountability. Most directly, however, an agency’s decision to seek backdoor revisions to its rules through interpretations announced in litigation deprive the agency of the benefit of public comment that can provide critical data and analysis to inform the agency’s policymaking. Had the DOL engaged in notice and comment, as it should have done, commenters would have presented key distinctions between the disability- and health-benefit contexts; without that information, the DOL’s decision was not fully informed.

ERIC and the Chamber are frequent amici in cases concerning ERISA and the APA’s interpretation and requirements. While the Supreme Court grants only a tiny fraction of the petitions it receives each term, the amici are hopeful that this brief will help focus the Court’s attention on this [...]

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EEOC Proposes New Rules on Wellness Programs

On January 7, 2021, the Equal Employment Opportunity Commission (EEOC) issued proposed guidance regarding employer-sponsored wellness programs and the level of incentives employers may offer employees who participate in these programs in the form of two proposed rules. On January 20, 2021, the Biden administration ordered agencies to immediately withdraw most unpublished rules, including the EEOC proposed rules. Agencies may not issue any new regulations until they can be reviewed and approved by agency or department heads appointed or designated by President Biden.

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Consolidated Appropriations Act: Health and Welfare Benefits Provisions

The Consolidated Appropriations Act (the Act) was signed into law by the president on December 27, 2020, and includes significant health and welfare benefits provisions that affect group health plans and health insurance issuers. The Act is the most comprehensive single piece of legislation to impact group health plans since the Affordable Care Act.

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Digital Health as Healthcare Delivery: A Path to Transform Care Delivery Post-Pandemic

As has been widely noted, the COVID-19 pandemic has prompted countless people to rely on telehealth and virtual monitoring for their healthcare needs. This dramatic pivot is catalyzing a demand for digital health tools that will persist post-pandemic, as providers, payers and patients alike grow accustomed to the benefits of digital care.

In a recent article for MedTech Intelligence, McDermott partner Jennifer S. Geetter outlines specific steps that digital health technology developers and providers can take to integrate digital health into our care delivery system.

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Healthcare Employers: What You Need to Know about the New FFCRA “Health Care Provider” Exclusion and California COVID-19 Supplemental Paid Sick Leave

Healthcare employers are immediately impacted by two recent developments in federal and California COVID-19 paid leave laws: a Department of Labor revision to the Families First Coronavirus Response Act (FFCRA) and a new California supplemental paid sick leave legislation. For both changes in the law, quick action is required for compliance.

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The 10 Most Significant Matters CEOs Should Know About Their Employment Contracts

The most significant issues in any employment or severance agreement are going to be personal to that situation, and will be driven in part by special issues and circumstances. For instance, succession planning issues may be incredibly important to the organization when the CEO is 65 years old and there is no clear successor, and may be far less important when the CEO is 45 and there are very able executives ready to assume the CEO role if necessary. With that said, there are certain considerations to keep in mind for all who are drafting these contracts.

McDermott’s Ralph E. DeJong contributes to an article in The Practical Lawyer that identifies and describes what frequently are the most important considerations in an employment or severance agreement between an exempt organization and its CEOs.

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Originally published in The Practical Lawyer, December 2019




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Federal Court Certifies Class in Multiple-Plan ERISA Challenge to Health-Plan and Retirement-Plan Fees

A Texas federal court certified a class in case brought by participants in one plan, and allowed those participants to represent participants in unaffiliated plans. The claims alleged that the defendants, who marketed and provided services to all of the plans, breached fiduciary duties by imposing excessive fees. See Chavez, et al. v. Plan Benefits Services, Inc., et al., No. AU-17-CA-00659-SS, United States District Court for Western District of Texas (Aug. 30, 2019).

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Transgender Health Benefits: Best Practices and Legal Considerations

A growing number of medical organizations, courts and administrative bodies have stated that transition-related medical care is medically necessary and should be covered by employer-sponsored medical plans. Access to employer-sponsored healthcare coverage for transgender workers has become an issue of focus for civil rights advocacy groups such as Lambda Legal and the American Civil Liberties Union, and there has been an uptick in discrimination lawsuits filed against health plans and insurers denying such care.

These trends highlight the importance of weighing the legal and business considerations that come with providing (or not providing) comprehensive health benefits for transgender workers. Health plan sponsors and insurers should consider how the decision to provide or exclude transition-related medical coverage will affect their legal compliance, overall costs and workplace culture—all of which are discussed in this article.

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Originally published in Benefits Magazine, August 2019.




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IRS Regulations Provide That Certain Employees of Partnerships Now Have Self-Employment Status for Employee Benefit and Tax Purposes

The IRS and US Department of Treasury have issued final and temporary regulations which address benefit and self-employment tax issues regarding partners in a partnership which is the sole owner of a second, wholly owned legal entity. The regulations are intended to clarify that where the partners are separately working for the second legal entity, such individuals may not be treated as employees, and must be treated as self-employed individuals for both self-employment and employee benefit plan purposes.  As a result, the partners may not be provided the tax benefits provided employees with respect to benefit plans such as cafeteria plans, parking and transit benefits, health benefits and health insurance.

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Live Audio Conference: Why Is This Guy Still on My Health Plan?

Lorman Education Services Live Audio Conference

Why Is This Guy Still on My Health Plan?
September 26, 2011
1:00 pm (EST), (12:00 p.m. [CST], 11:00 a.m. [MST], 10:00 a.m. [PDT])

1 hour 30 minutes

Instructor:  Amy Gordon, Co-Chair of McDermott Will & Emery’s Health and Welfare Benefits Group

Companies have encountered many situations where an employee remains on the company’s health benefits as an active employee for many years past the date in which the employee was actively at work for the company, both intentionally and unintentionally.  This live audio conference will answer a common problem employers experience: what date should an employee be treated as a terminated employee when he/she is on a leave of absence or fails to return from a leave of absence, and how does this coordinate with the company-provided health and welfare benefits? This program will discuss the legal issues surrounding a leave of absence.  It will explore how an employee may fall through the cracks and how to possibly change the administrative process. Finally, the program will address some of the potential pitfalls given the new Health Care Reform rules.

This live audio conference is designed for human resource managers, benefits administrators, payroll managers, controllers, CFOs, presidents, vice presidents, business and office managers, insurance professionals and attorneys.

Click here to register for the audio conference.

To receive a 20% discount courtesy of McDermott Will & Emery, please enter this code: 9696163.




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