Federal Health & Welfare Updates

On April 11, 2024, in Ryan S. v UnitedHealth Group, Inc., et al., the Ninth Circuit Court of Appeals (Ninth Circuit) filed a decision reversing a Middle District of California District Court dismissal of a class action suit brought under ERISA by a beneficiary (Ryan S.) of a group health plan insured, managed, and administered by UnitedHealthcare (UHC). The lawsuit, which alleged a MHPAEA violation and breach of an ERISA fiduciary duty, was remanded for further proceedings. Between 2017 and 201

On April 2, 2024, the HHS, CMS, and IRS released the 2025 Notice of Final Benefit and Payment Parameters (the 2025 final rule), an accompanying fact sheet, and, in coordination with the DOL, a related FAQ. The 2025 final rule, which follows a proposed rule issued on November 15, 2023, is primarily directed at health insurers and the ACA marketplace but includes certain information that directly or indirectly impacts group health plans. Notably, the final rule and FAQ codify that prescription dr

In February 2024, HHS and the National Institute of Standards and Technology (NIST) released an updated cybersecurity resource guide to help HIPAA-regulated entities, which include group health plans and their business associates, comply with the HIPAA Security Rule (the Security Rule). This practical guide is organized into five main sections, followed by a wide variety of related resources in the appendices. Section 1, the introduction, explains the purpose of the guide and outlines its conte

On March 24, 2024, in McKee Foods Corporation v. BFP, Inc. dba Thrifty Med Plus Pharmacy, the Sixth Circuit US Court of Appeals (Sixth Circuit) held that McKee Foods' claims that Tennessee's "any willing pharmacy" ("any-willing-pharmacy") laws are preempted by ERISA, and that state law does not require it to include Thrifty Med in its approved network of pharmacies, were not rendered moot following changes to the underlying state laws and other factual developments in the case. The Sixth Circui

On March 19, 2024, a federal trial court held that the hearing-impaired mother and daughter stated a sufficient claim of "proxy" discrimination under ACA Section 1557 against Regence BlueShield, a health insurer, for its plans' exclusion of all hearing devices except cochlear implants to proceed to trial. ACA section 1557 prohibits discrimination in certain health programs or activities based on race, color, national origin, sex, age, or disability. "Proxy" discrimination can result from (in th