From the Johnson & Johnson fiduciary breach, to the Affordable Care Act preventive care mandate, to the Supreme Court’s decision overruling prior precedent in a case commonly known as Chevron, this year has been a busy one for litigation impacting employers with group health plans.In this episode, Alliant’s in-house benefits compliance attorneys di…

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 ple…

In this episode of The Proskauer Benefits Brief, David Teigman, partner in the Tax Department and a member of the Employee Benefits & Executive Compensation Group, Josh Apfelroth, partner in the Private Equity and Mergers & Acquisitions Group and Nick LaSpina, senior counsel in the Employee Benefits and Executive Compensation Group discuss sharehol…

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 importa…

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 amoun…

Join us for a special edition of Compliant with Alliant where our Compliance and Pharmacy practices team up to share some thoughts about the class action complaint filed against Johnson & Johnson. We'll go over what to consider as you evaluate not just your pharmacy benefits, but your benefit plan as a whole.…

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 …

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 informat…

This episode is brought to you by the letter G! Listen as our employee benefits compliance experts discuss a number of hot topics including gender affirming surgery, gene therapy drugs, and gag clause attestations. Also, stick around for a health and welfare plan litigation update.By Alliant Employee Benefits

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…

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 …

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 an…

Fraud With Fred: Unbundling and Upcoding Fraud Trends by Novara LawBy Novara Law

Open and Obvious No More?: Michigan Supreme Court's Ruling in Kandlil-El Sayed v F & E Oil, Inc. by Novara LawBy Novara Law

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 …

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 i…

In this episode, Chase Cannon and Suzanne Spradley discuss a recent IRS memo on wellness benefit payments via employer-funded fixed indemnity plans. Chase outlines the various iterations and structure of vendor-promoted wellness programs, which usually purport huge employment tax savings for employers. Chase and Suzanne outline the relevant tax rul…

In this episode, Suzanne Spradley and Chase Cannon review the CAA’s prohibition on gag clauses in TPA and service provider contracts, as well as the employer’s obligation to attest to the removal of gag clauses (due December 31, 2023, for the first time). Suzanne outlines the challenges employers and plans face when working with TPAs, and explores …

In this episode, Chase Cannon and Suzanne Spradley discuss updates on the ACA preventive care mandate litigation, including a stay issued by the Fifth Circuit Court of Appeals. HSA contribution limits become a topic of discussion, as the IRS recently published updated numbers. Chase and Suzanne also discuss a common problem for employers filing For…

In this episode, Suzanne Spradley and Chase Cannon have a look at the national debt and debt ceiling and how they impact employers and their group health plans. Suzanne leads off with a discussion on the national debt and how Congress sets the debt ceiling. Suzanne and Chase go in depth on what a failure to raise the debt ceiling and/or default on …

In this episode, Chase Cannon and Suzanne Spradley review several recent HIPAA violation settlements from the HHS Office for Civil Rights. Chase starts off by reviewing the general HIPAA obligations of fully and self-insured plans, including the importance of a HIPAA risk assessment. Chase and Suzanne discuss three real-life scenarios outlining way…

In this episode, Suzanne Spradley and Chase Cannon discuss a recent Texas court ruling that invalidates a portion of the ACA’s preventive services coverage requirement. Suzanne provides a background of the plaintiffs and their arguments, including a Constitutional problem with the way the government appointed officers under the ACA and a religious …

In this episode of The Proskauer Benefits Brief, David Teigman, partner in the Employee Benefits and Executive Compensation Group, Simon Sharpe, partner and member of our Private Equity and Mergers & Acquisitions groups and Nick LaSpina, senior counsel in the Employee Benefits and Executive Compensation Group discuss rep and warranty insurance (RWI…

Earlier this year, the Biden Administration announced the end of the National and Public Health Emergencies effective May 11, 2023. Each of these emergency declarations created significant relief in terms of plan coverage and deadline extensions. Join our compliance attorneys as they go over what this means for employer sponsored group health plans…

In this episode of The Proskauer Benefits Brief, Proskauer partners Ira Bogner and Adam Scoll and law clerk Tanusha Yarlagadda discuss the Department of Labor’s final ESG rules issued on November 22, 2022, and how those rules affect the consideration by ERISA fiduciaries of environmental, social, and governance or “ESG” factors when making investme…

In this episode, Chase Cannon and Suzanne Spradley address recent IRS guidance that mandates electronic filing of certain tax forms – including Forms 1095-C – for smaller employers. Chase describes the background from Congress and the IRS and explains what it means now that any employer filing 10 or more forms (previously, this was 250) will be req…

Property Tax and Cannabis Grow Operations by Novara LawBy Novara Law

In this episode, Suzanne Spradley and Chase Cannon discuss potential activity at the federal and state level relating to PBM transparency. Suzanne begins the discussion by outlining a few proposals from Congress that attempt to hold PBMs accountable for unfair and deceptive practices that may be driving up prescription drug costs. Suzanne then addr…

2022 No-Fault Year in Review by Novara LawBy Novara Law

In this episode, Beth Allen and Chase Cannon look at several new developments for plan compliance in 2023. The two start with the recent announcement on the end of the COVID-19 public health emergency, which impacts the outbreak period and extension of timeframes for certain compliance deadlines. Chase then dives in on the CAA 2023 extension of rel…

In this episode, Suzanne Spradley and Chase Cannon highlight several areas of healthcare policy and compliance that will be on center stage in 2023. Suzanne starts with a discussion of transparency in healthcare and prescription drug costs, including several compliance requirements that will take effect in 2023. Suzanne and Chase discuss state comp…

Novara Law Win for Insurers in Opiate Epidemic Litigation by Novara LawBy Novara Law

Cyber Security and ERISA with Senior Partner Paul Catenacci by Novara LawBy Novara Law

In this episode, Suzanne Spradley and Chase Cannon discuss several recent COBRA cases. Suzanne starts by outlining several class action lawsuits filed against employers and plan sponsors relating to deficiencies in an employer health plan’s COBRA election notice. Suzanne and Chase discuss the use of the DOL’s Model Election Notice and how that usag…

In this episode, Chase Cannon and Suzanne Spradley discuss three recent court rulings—all at the district court level. Chase outlines the first case relating to a COBRA election notice failure, including takeaways for employers to enhance their notice distribution procedures. Chase and Suzanne dive into an ACA-related case challenging gender-affirm…

Andary v USAA Casualty Insurance Company Update by Novara LawBy Novara Law

In this episode, Suzanne Spradley and Chase Cannon walk through recent activity in the House and Senate relating to several new laws under consideration on coverage of mental health services. Suzanne starts by reviewing some potential changes relating to Medicare coverage of mental health services, such as required behavioral health monitoring for …

This episode covers the new pharmacy and healthcare spending reporting requirements. Alliant's compliance experts discuss challenges to be aware of, employer action items, and Alliant support solutions.By Alliant Employee Benefits

In this episode, Chase Cannon and Suzanne Spradley discuss the benefits provisions of the recently-enacted Inflation Reduction Act. Chase walks through the extension of premium tax credit expansions through 2025, and the impact on employers with respect to the employer mandate penalties. Next, Chase and Suzanne discuss Medicare prescription drug co…

In this episode, Chase Cannon and Suzanne Spradley recap the past few weeks’ guidance relating to Post-Dobbs considerations on employer coverage and reimbursement of abortion-related services. Chase starts by comparing the approaches of two different states – Texas and New Jersey – with respect to the legality of abortion services. New laws and dev…

Hosted by Genavieve HilgenbrinkBy Novara Law

In this episode, Suzanne Spradley and Patrick Myers discuss recent guidance concerning the interaction between FMLA and mental health conditions. Suzanne provides some context for this guidance and a brief refresher on FMLA itself. Suzanne and Patrick then discuss how mental health conditions can apply in a FMLA context, including when a mental hea…

Hosted by Genavieve HilgenbrinkBy Novara Law

In this episode, Suzanne Spradley and Chase Cannon discuss hospital prices and their impact on employer group health plans. Suzanne describes this issue as it relates to the new transparency in coverage rules. Suzanne and Chase review a recent study that reviews hospital prices nationwide, including Medicare-certified, short-stay and other facility…

In this episode of The Proskauer Benefits Brief, partner David Teigman, senior counsel Nick LaSpina, and special international labor & employment counsel Nicola Bartholomew, discuss differences between asset sales in the US and the UK, with respect to transfers of employees. In short, there are significant differences that are not necessarily intui…

In this episode, Chase Cannon and Suzanne Spradley look at the recent rise in so-called “point solution programs.” These add-on programs enhance or expand on a group health plan offering and have benefits such as mental health, musculoskeletal, life coaching and fertility. Chase explains some of the compliance challenges that arise from offering th…

In this episode, Suzanne Spradley and Chase Cannon update us on employer compliance obligations under the Transparency in Coverage (TIC) rules. Suzanne begins with an overview of the TIC rules and how they are meant to address consumerism and rising health care costs. Suzanne and Chase then hone in on the actual requirements, including posting of p…

In this episode, Chase Cannon and Sarah Burns revisit recent mental health claims litigation under the Employee Retirement Income Security Act (ERISA) and the Mental Health Parity and Addiction Equity Act (MHPAEA). Sarah begins with a discussion of the class action lawsuit Wit, et al. v. United Behavioral Health, overturned by the 9th Circuit on Ma…

Join NFP’s own Head of Innovation, Mark Rieder, as he discusses what innovation looks like at NFP and how to start your own innovation journey with Naviant’s Ema Roloff on their “Digital Transformation Talks” podcast series. Discussion points include: • How to engage a team in innovation• How to support continual education within an organization • …

In this episode, Patrick Myers and Suzanne Spradley review recent litigation and administrative action brought under the Mental Health Parity and Addiction Equity Act (MHPAEA). Suzanne begins the discussion by providing background on the requirements imposed on plans by MHPAEA, with a particular focus on non-quantitative treatment limitations (NQTL…