On March 6, 2024, the IRS issued an alert (IR-2024-65) to remind taxpayers and health spending plan administrators that personal expenses for general health and wellness are not considered medical care. Therefore, these expenses are not reimbursable through health FSAs, HRAs, HSAs, and MSAs.

A recently filed lawsuit focuses on ERISA fiduciary obligations of employers in their role as group health plan sponsors, particularly the “duty of prudence” in selecting and monitoring health plan vendors. Specifically, the lawsuit involves a prescription drug plan’s benefits and management, including the plan’s usage of pharmacy benefit managers (PBMs). The lawsuit alleges that as a result of fiduciary failures, plan participants and beneficiaries were required to pay increased costs and premiums and thus harmed.

On February 9, 2024, in Watson v. EMC Corp., the US Court of Appeals for the Tenth Circuit ruled that an employer may be liable for the value of group life insurance benefits that would have been available under an insured policy absent the employer’s failure to adequately inform the employee of the plan’s conversion requirements.

On February 14, 2024, the HHS Office for Civil Rights (OCR) released two annual reports to Congress summarizing the agency's key HIPAA enforcement activities during the 2022 calendar year as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The first report, HIPAA Privacy, Security, and Breach Notification Rule Compliance, identifies the number of complaints received, the method by which those complaints were resolved, and other OCR HIPAA compliance enforcement activities.

On February 8, 2024, HHS released a final rule modifying the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations under 42 CFR Part 2 (referred to as “Part 2”). The final rule implements confidentiality rules required under the CARES Act to align certain aspects of Part 2 with HIPAA rules.

The IRS recently released the updated Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans for use in preparing 2023 tax returns. This publication provides information about consumer-directed healthcare vehicles such as Health Savings Accounts (HSAs), Medical Savings Accounts (MSAs), Flexible Spending Arrangements (FSAs) and Health Reimbursement Arrangements (HRAs).

On December 5, 2023, in <em>Ian C. v. United Healthcare Ins. Co.</em>, the Tenth Circuit Court of Appeals (Tenth Circuit) reversed the district court’s ruling that the defendant’s claim denial was not arbitrary and capricious because the defendant did not provide a “full and fair review” of the plaintiff’s claims.

On February 2, 2024, the DOL, HHS, and IRS (the departments) issued FAQ guidance on the implementation of certain requirements under the Transparency in Coverage (TiC) Final Rules. This FAQ clarifies the participant cost-sharing tool compliance requirements where a plan is providing cost estimates based on claims data, but there is extremely low utilization of the item or service at issue.

In January, the DOL issued five fact sheets that focus on different aspects of the FMLA.

On December 19, 2023, the US Court of Appeals for the Eleventh Circuit (the Eleventh Circuit) filed an opinion in W.A. Griffin, MD v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. , per curiam, affirming the decision of the district court that an assignment of benefits by a patient to a medical provider did not include sufficiently explicit language to transfer the right to bring nonpayment, statutory penalty suits under ERISA.