In this episode, Chase Cannon and Suzanne Spradley discuss the recent revival of vendor-promoted pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment. Chase leads off with a brief description of these programs and their purported claims on employment tax savings for both employees and employers. Chase and Suzanne review the various iterations of the programs, explain how their tax-free reimbursements are not allowed under the related rules, and discuss how the IRS has attempted to address their illegitimacy through several pieces of guidance. Chase closes out the podcast by identifying red flags to help listeners recognize these problematic programs.

In this episode, Suzanne Spradley and Chase Cannon review the current state and federal regulation of pharmacy benefit managers (PBMs), focusing on litigation surrounding recent state-enacted PBM rules. Suzanne starts off with a high-level description of PBMs and the role they play in the group health plan context. Suzanne and Chase discuss the plethora of state laws (proposed and enacted) focused on PBM regulation and the role courts have played in ERISA preemption of state laws, including in Arkansas, Oklahoma, and North Dakota. Suzanne concludes with a discussion of ERISA fiduciary obligations in the context of the J&J lawsuit, including a few employer takeaways on establishing a process for making plan-related decisions on pharmacy and other benefits and administration.

In this episode, Suzanne Spradley and Chase Cannon discuss the US importation policies and rules aimed at lowering domestic prescription drug costs. Suzanne walks through the legalities of drug importation generally and then outlines the specific programs by which states can develop importation plans. Chase and Suzanne discuss several state importation proposals and how they could potentially bring savings to US consumers. Suzanne closes by addressing Canadian concerns relating to potential US drug importation.

In this episode, Chase Cannon and Suzanne Spradley remind employers about important ACA employer mandate reporting deadlines with the IRS, including a change in electronic reporting in 2024 for smaller employers. Chase also outlines some updated numbers relating to the federal poverty line (FPL), ACA affordability calculations and ACA penalty amounts, which are all adjusted annually. Suzanne and Chase finish with a discussion on an IRS alert regarding wellness vendors that are erroneously claiming certain expenses are “medical care” under the IRS rules.

In this episode, Suzanne Spradley and Chase Cannon give an overview of the No Surprises Act (NSA) — a consumer health protection law that places certain requirements on providers and payers (insurers and group health plans). Suzanne describes the main requirements under the NSA and introduces the Independent Dispute Resolution (IDR) process, which is an integral part of the NSA’s implementation. Suzanne and Chase discuss the challenges facing the IDR in its first few years, as well as the legal challenges to the federal guidance outlining IDR procedures and practices. Suzanne closes with a discussion of what to look for in 2024 and how the NSA and IDR may impact employers.

In this episode, Chase Cannon and Suzanne Spradley discuss employer compliance with the HIPAA privacy and security rules via lessons learned from three new HHS HIPAA settlement announcements. Chase leads off with a high-level review of the HIPAA rules for both fully and self-insured plans and the importance of safeguarding protected health information (PHI). Chase and Suzanne discuss the background and scenarios that led to the HHS investigation, how unauthorized access to PHI arose in the three settlement scenarios, and the importance of employers running a HIPAA risk assessment to get ahead of potential HIPAA problems. Chase and Suzanne share practical tips on HIPAA compliance, including training employees, involving IT and Technology teams when developing policies and procedures, and controlling access points (servers, emails, etc.) to electronic and physical PHI.

In this episode, Suzanne Spradley and Chase Cannon discuss a recent circuit-level decision relating to employee termination and its interaction with a participant lawsuit based on ERISA Section 510 (which prohibits an employer’s interference with a plan participant’s right to benefits). Suzanne provides background on ERISA 510 and how it applies to employer’s group health plans. Suzanne and Chase analyze a case where an employer terminated an employee shortly after their return to work following a leave of absence for a medical procedure. The two close by discussing how the court weighed certain factors when determining the employer violated the participant’s Section 510 rights.

In this episode, Chase Cannon and Suzanne Spradley take a tour across the nation as they review several new regulatory developments in six states that could impact employers with employees or fully insured plans in those states. Chase outlines new or recently effective paid family leave rules in New York, Oregon, and Maine. Chase and Suzanne delve into the impact of 2024 rate adjustments relating to San Francisco’s Health Care Security Ordinance and New York’s Paid Family Leave laws, including updated notices and other information on which employers need awareness. The two attorneys also highlight several new Texas laws that implicate multiple employer welfare arrangements (MEWAs) and fully insured plan coverage of prescription drugs and ground ambulance services.

In this episode, Suzanne Spradley and Chase Cannon address a recent appellate-level court case that addresses ERISA preemption of a recently enacted Oklahoma state law regulating pharmacy benefit managers (PBM). Suzanne begins by laying the groundwork and history of ERISA and ERISA preemption. Suzanne and Chase discuss the Oklahoma state PBM law and the players in the court case challenging the applicability of that state law. Suzanne details the court’s analysis on the circumstances required for ERISA to preempt (overrule) a state law, and she covers the court’s opinion and decision. Suzanne and Chase conclude the podcast by discussing the impact of the court’s decision on employers.

In this episode, Chase Cannon and Suzanne Spradley discuss recent enforcement on MHPAEA. Chase jumps in with a description of DOL’s enforcement approach, including working through TPAs to identify plans that have or had ABA therapy exclusions. Suzanne and Chase discuss the administrative challenges with reprocessing ABA exclusion claims, which the DOL is asking TPAs to assist plans with. The two close with a high-level review of the recent DOL Enforcement Fact Sheet and promise a more in-depth review of the recent MHPAEA proposed regulations and report to Congress on the next podcast.

In this episode, Suzanne Spradley and Chase Cannon review several new pieces of proposed federal legislation coming out of the House. Suzanne discusses the Transparency in Billing Act, which requires hospitals to have better and more accurate billing practices, policies and procedures with respect to outpatient departments. Suzanne and Chase dive into two other proposed bills aimed at PBMs and prescription drug pricing and creating a more shoppable healthcare system. Suzanne closes with some highlights on a proposed bill aimed at increasing transparency in fees from PBMs and TPAs.