On May 15, 2023, in D.K., et al. v. United Behavioral Health, et al., the United States Court of Appeals for the Tenth Circuit (the Tenth Circuit) found that ERISA health claims administrators must engage with treating physician opinions when reviewing claims on appeal and explain their reasoning in denial letters. While deference to a claimant’s treating physician is not required, the Tenth Circuit confirmed such evidence could not be...

On May 16, 2023, the IRS released Revenue Procedure 2023-23, which provides the 2024 inflation-adjusted limits for HSAs and HSA-qualifying HDHPs. According to the revenue procedure, the 2024 annual HSA contribution limit will increase to $4,150 for individuals with self-only HDHP coverage (up $300 from 2023) and to $8,300 for individuals with anything other than self-only HDHP coverage (family or self +1, self + child(ren), or...

On April 13, 2023, in celebration of Autism Awareness Month, the DOL’s Employee Benefits Security Administration (EBSA) Assistant Secretary, Lisa M. Gomez, publicly reaffirmed the agency’s commitment to ensuring access to autism treatment benefits.

The CMS has released the latest update regarding the federal Independent Dispute Resolution (IDR) portal.

On March 29, 2023, the IRS Chief Counsel’s office published a memorandum that addresses the claim substantiation requirements for health FSA and dependent care assistance program (DCAP) expenses. The memo illustrates the situations when an expense fails to be properly substantiated in accordance with IRS rules. The memo affirms that any health FSA and DCAP expense, regardless of the amount, must be fully...

On April 19, 2023, the DOL announced a settlement with Prudential Insurance Company of America (Prudential) following an investigation into the carrier’s group supplemental life insurance claims practices. The DOL investigation found that Prudential, based on the terms of its group life insurance policies, has denied claims for failure to provide evidence of insurability (EOI) after collecting supplemental life insurance premiums...

On April 12, 2023, the HHS Office of Civil Rights (OCR) issued a Notice of Proposed Rulemaking that will expand reproductive healthcare privacy under HIPAA.

Following the US Supreme Court’s lead, a trial court has changed its view as to whether a church-affiliated hospital’s retirement plan qualifies as a “church plan” under ERISA.

The ACA requires the DOL to provide Congress with an annual report regarding private-sector self-insured health benefits plans and financial information of employers that sponsor such plans. The DOL recently released the 2023 annual report based on 2020 Form 5500 filings, including the number of participants, benefits offered, funding arrangements and plan assets. Along with the annual report, the DOL released two detailed appendices to complement the report: Appendix A, which describes the abstract of 2020 Form 5500 Annual Reports and Appendix B,...

CMS recently released the Prescription Drug Data Collection Reporting Instructions for the 2022 calendar year (the 2022 RxDC instructions). The 2022 RxDC instructions reflect numerous changes from the prior year’s instructions.