On October 21, 2024, the DOL updated its FAQs for the ACA and the Women’s Health and Cancer Rights Act (WHCRA) by adding FAQ Part 68. These new FAQs concern issues relating to preventive services, including coverage of Pre-Exposure Prophylaxis (PrEP) and insurance coding practices, as well as coverage for a specific breast reconstruction technique. 

On October 30, 2024, the Fifth Circuit Court of Appeals (Fifth Circuit) reversed a district court’s decision to vacate certain regulations promulgated by three federal agencies: the DOL, HHS, and IRS (the agencies).

On October 8, 2024, CMS released the proposed Notice of Benefit and Payment Parameters Rule for 2026. This notice is issued annually preceding the applicable benefit year and, once final, adopts certain changes. Additionally, CMS issued Premium Adjustment Percentage and related guidance to inform the payment parameters for the 2026 benefit year.

On October 17, 2024, the IRS published two notices (Notice 2024-71 and Notice 2024-75) to expand and clarify the list of preventive care benefits that are permitted under an HDHP without a deductible or with a deductible below the applicable minimum deductible for the HDHP.

On October 1, 2024, in M.S., et al v. Premera Blue Cross, et al, the United States Court of Appeals for the Tenth Circuit (the Tenth Circuit) vacated a lower court’s MHPAEA violation judgment because the plaintiffs lacked standing to bring a MHPAEA claim against the defendants in federal court. 

Currently, the Fifth Circuit Court of Appeals (Fifth Circuit) is considering an appeal by air ambulance providers Guardian Flight, LLC and Med-Trans Corporation (appellants) of a district court decision dismissing their claim against insurer Health Care Service Corporation (appellee).

On September 25, 2024, in Knudsen v. MetLife Group Inc., the Third Circuit Court of Appeals (Third Circuit) affirmed the dismissal of a putative class action lawsuit claiming ERISA violations by defendant MetLife for its retention of prescription drug plan rebates.

Certain pre-tax wellness arrangements that promise large tax savings for employers and employees with little employer investment (sometimes referred to as “wellness indemnity plans” or “FICA savings programs”) frequently lack a legitimate basis in tax law (the Internal Revenue Code (IRC)) and consequently are typically too good to be true. 

On September 19, 2024, in Dwyer v. United Healthcare Ins. Co., the United States Court of Appeals for the Fifth Circuit (the court) found that defendant United Healthcare (UHC) improperly denied benefits for the continuing treatment of a participant’s anorexia nervosa, disregarding both the plan’s own coverage terms and its claims and appeals procedures.

HHS's Office for Civil Rights (OCR) has recently released its latest cybersecurity newsletter to remind HIPAA-covered entities, which include employer-sponsored health plans, and business associates (collectively, “regulated entities”), that physical security measures such as facility access controls are essential for HIPAA Security Rule compliance. These measures help prevent unauthorized access to electronic protected health information (ePHI) as the incidences of cyberattacks and breaches of ePHI are increasing.