NFP's Insights from the Experts

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 information (PHI). Chase and Suzanne discuss the backgroun...

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 employer’s group health plans. Suzanne and Chase...

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 into the impact of 2024 rate adjustments relating...

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 and the players in the court case challenging the ap...

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 DOL is asking TPAs to assist plans with. The two c...

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 into two other proposed bills aimed at PBMs and pre...

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 rules and where these programs usually run afoul of t...

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 how recent guidance attempts to address those chal...

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 Form 5500 with respect to missing Schedule A informat...

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 debt could mean for the healthcare industry. Suzan...

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 ways in which companies experienced HIPAA breaches. C...

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 freedom violation. Suzanne and Chase discuss the c...

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 required to do so through the IRS electronic filing s...

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 addresses a few state proposals that attempt to regula...

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 relief for telehealth services in conjunction with HS...

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 compliance challenges, including abortion travel cover...

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 usage interacts with potential DOL regulatory fines an...

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-affirming care guidance published by HHS earlier in 2022...

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 suicide ideations and the need for interventions s...

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 cost reductions and a formalization of prior IRS gui...

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 developments in each of those states highlight the ch...

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 health condition is a “serious health condition” or a...

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 types. Suzanne discussing the findings of the stu...

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 the programs, including ERISA, COBRA, and ACA issues...

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 plan information, with both in-and-out-of-network r...