The Consolidated Appropriations Act, 2021 (CAA) added a requirement for health plans to document their compliance with nonquantitative treatment limitations (NQTLs) under the Mental Health Parity and Addiction Equity Act...more
9/21/2023
/ Consolidated Appropriations Act (CAA) ,
Department of Labor (DOL) ,
Employer Group Health Plans ,
Mental Health Parity Rule ,
MHPAEA ,
New Guidance ,
NQTLs ,
Opioid ,
Proposed Rules ,
Substance Abuse ,
U.S. Treasury
In Thole v. U.S. Bank, N.A., 140 S Ct. 1615 (2020), the Supreme Court, in a five to four decision authored by Justice Kavanaugh, held that participants in an ERISA defined benefit pension plan did not have standing under...more
8/16/2023
/ Article III ,
Breach of Duty ,
Defined Benefit Plans ,
Employee Retirement Income Security Act (ERISA) ,
Fiduciary Duty ,
Injury-in-Fact ,
MetLife ,
MEWAs ,
Mismanagement ,
Pensions ,
Pharmacy Benefit Manager (PBM) ,
Plan Participants ,
Retirement Plan ,
SCOTUS ,
Standing ,
Thole v U.S. Bank
We usually focus most on significant ERISA court decisions, particularly those from the Supreme Court, that clarify important open legal issues under ERISA. However, some ERISA court decisions simply serve as important...more
The Consolidated Appropriations Act, 2021 (CAA) generally requires group health plan sponsors to request and review fee information from their plan service providers who provide brokerage services or consulting. This fee...more
Last December, the U.S. Supreme Court unanimously held that provisions of an Arkansas law that regulated the use by pharmacy benefit managers (“PBMs”) of maximum allowable cost programs to limit retail pharmacy reimbursement...more
Recent court trends suggest that preemption under the Employee Retirement Income Security Act (ERISA) may not apply to certain state laws that regulate pharmacy benefit managers (PBMs), including state laws governing Maximum...more
6/16/2021
/ Drug Pricing ,
Employee Retirement Income Security Act (ERISA) ,
Health Insurance ,
Pharmaceutical Industry ,
Pharmacies ,
Pharmacy Benefit Manager (PBM) ,
Preemption ,
Prescription Drug Coverage ,
Prescription Drugs ,
Rutledge v Pharmaceutical Care Management Association ,
SCOTUS
Recently, a three-judge panel in the Court of Appeals for the Ninth Circuit overturned a district court dismissal of an out-of-network provider’s claims against Blue Cross and Blue Shield of Illinois (“BCBSIL”). The unanimous...more
Some found it somewhat ironic when, only one week before the Acting Solicitor General appeared before the United States Supreme Court to argue that Congress effectively repealed the entire Affordable Care Act (“ACA”) in...more
On October 26, 2020, the Small Business Administration (SBA) published notice in the federal register that it is seeking approval from the government’s Office of Management and Budget (OMB) to release two new forms (Form 3509...more
11/13/2020
/ Business Interruption ,
CARES Act ,
Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Liquidity ,
Loan Forgiveness ,
OMB ,
Paycheck Protection Program (PPP) ,
Questionnaires ,
SBA
The Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), which was signed by the President on March 27, 2020, includes several provisions affecting taxes.
SEC. 2201. 2020 Recovery Rebates for Individuals...more
3/30/2020
/ Business Closures ,
Business Interruption ,
CARES Act ,
Coronavirus/COVID-19 ,
Federal Loans ,
Financial Stimulus ,
Paycheck Protection Program (PPP) ,
Payroll Taxes ,
Relief Measures ,
SBA ,
SBA Lending Programs ,
Small Business ,
Tax Relief ,
Unemployment Insurance
In January, the Supreme Court agreed to accept an appeal filed by the State of Arkansas of a decision by the Eighth Circuit Court of Appeals finding that Section 514 of ERISA expressly preempted the state’s maximum allowable...more
On January 17, 2013, the Office for Civil Rights of the U.S. Department of Health and Human Services (HHS) issued the long-awaited omnibus final rule (the Rule) implementing changes in current regulations under the Health...more
1/24/2013
/ Business Associates ,
Data Breach ,
Data Protection ,
Department of Health and Human Services (HHS) ,
Disclosure Requirements ,
Enforcement ,
Fundraisers ,
GINA ,
Health Insurance Portability and Accountability Act (HIPAA) ,
HIPAA Omnibus Rule ,
HITECH Act ,
Marketing ,
OCR ,
PHI ,
Privacy Policy