Over the past two weeks, wildfires have caused substantial loss and damage to homes and communities in Los Angeles, California, and the surrounding areas. In the wake of such devastation, employers may seek opportunities to provide financial assistance to impacted employees. Fortunately, the Internal Revenue Service (IRS) has outlined various ways for employers to provide much-needed assistance to employees impacted by natural disasters like the wildfires, including tax-free qualified disaster relief payments, leave donation programs, and other tax-efficient options.
Gender-affirming care has become a central topic in US political discussions, significantly affecting employer-sponsored group health plans. Depending on whether they purchase insurance or self-fund their health benefits, group health plan sponsors face different challenges in covering gender-affirming care. In this PlanSponsor article, Alden Bianchi, Sarah Raaii, and Scott Kenkel explore these challenges and share best practices for group health plans to navigate this complex issue.
Many countries finalized new regulations and released new guidance in 2024 that will impact global equity plans. This client alert highlights key updates from Canada, the European Union, the United Kingdom, Brazil, and other jurisdictions, and recommends steps companies should take to address them.
Following a dynamic year, coupled with a continually evolving legal landscape, employers face increasing regulatory compliance, organized labor advances, technological changes, challenges in protecting company information and retaining talent, and new litigation trends.
In a recent webinar, McDermott’s industry-leading employment team unpacked the most pertinent legal updates and provided tips and action items to get ahead in 2025. They discussed new laws taking effect in the new year, explored key developments impacting management and the workforce, and provided guidance on what employers can anticipate this year.
The No Surprises Act, a law that ended the practice of “balance billing” by certain out-of-network providers, was enacted as part of the Consolidated Appropriations Act of 2021 on December 27, 2020. While the law was passed during President Trump’s first term in office, the Biden administration has been fully responsible for its implementation to date.
In this insight, McDermott+’s Jeffrey Davis and Kristen O’Brien highlight four major areas of No Surprises Act implementation that the Trump administration could decide to focus on in the months following the inauguration.
Payor contracting can seem daunting, particularly for new companies and innovative organizations that are unfamiliar with the nuances of providing a product to health insurers and health maintenance organizations. Navigating regulatory considerations and payor contract complexities requires a solid understanding of the basics. During this webinar, McDermott Partners Gregory Mitchell, Mimi Alexandre, and Erin Kelly discussed some key principles of payor contracting.
The Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires group health plans and health insurance issuers to ensure that financial requirements (such as copays and deductibles), quantitative treatment limitations (such as visit limits), and nonquantitative treatment limitations (such as prior authorization and concurrent review) applicable to mental health or substance use disorder (MH/SUD) benefits are generally no more restrictive than the requirements or limitations applied to medical/surgical (M/S) benefits. The Consolidated Appropriations Act, 2021 imposed further obligations in the case of nonquantitative treatment limitations (NQTLs), which are the subject of final regulations issued in September 2024. (We explained the final regulations here.)
Among many other things, the final regulations establish a two-part test that applies to NQTLs consisting of:
The design and application requirement. This test requires that the processes, strategies, evidentiary standards, or other factors used in designing and applying an NQTL to MH/SUD benefits in each classification must be comparable to and applied no more stringently than those used in designing and applying the limitation with respect to M/S benefits in that same classification. For this purpose, classifications include inpatient, in-network care; inpatient, out-of-network care; outpatient, in-network care; outpatient, out-of-network care; emergency care; and prescription drugs.
The relevant data evaluation requirement. This test requires the plan or issuer to collect and evaluate relevant data in a manner reasonably designed to assess the impact of the NQTL on relevant outcomes related to access to MH/SUD benefits as compared to M/S benefits. Relevant data for this purpose includes the number and percentage of relevant claims denials and network composition data.
The relevant data evaluation requirement has proven especially challenging for self-funded group health plans of every size, as third-party administrators fail, refuse, or are otherwise unable to provide the information necessary to comply. There may be another option, however.
The final regulations do not specify the data set on which compliance with the relevant data requirement is tested. Rather, the regulations, which apply to both plans and issuers, seem to assume that the plans test on the basis of plan data, and issuers test on the basis of the issuer’s corresponding block of business. In their informal remarks at trade and industry conferences, representatives of the US Department of Labor (DOL), expressing their own views and not those of the DOL, have acknowledged that they are aware of and are considering their options related to the proper testing data set.
Some large carriers have shared the NQTL analysis that they previously prepared for their fully insured groups with the self-funded group to whom they provide administrative services. Presumably, this will give their self-funded groups a starting point. Many self-funded groups, particularly smaller groups, are not inclined to modify the standard set of NQTLs offered by their carriers/administrative-service-only (ASO) providers. If these groups were allowed to test based on the carrier’s corresponding book of business, a good deal of the work would be done. This would also have the salutary effect of exerting market pressure [...]
On December 5, 2024, the US Department of Health and Human Services Office for Civil Rights issued a “Dear Colleague” letter reiterating obligations that covered entities have under the May 2024 final rule related to language access requirements under Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs and activities. The final rule strengthened many protections against discrimination in healthcare, including rules for providing language assistance to individuals with limited English proficiency (LEP) or disability. This Dear Colleague letter had the goal of outlining key requirements to ensure that covered entities provide meaningful language access to individuals in time for the June 5, 2025, deadline for full implementation.
With the 2025 plan year right around the corner, this is the ideal time for plan sponsors to ensure that plan operations comply with evolving legislative and regulatory requirements. This client alert highlights important regulatory changes that will impact retirement plans and health and welfare plans in the coming year.
The 2024 election results will create significant tailwinds for Republican legislative and regulatory priorities in US Congress, federal agencies, and state houses across the country. This client alert considers the outlook for pharmacy regulation under the second incoming Trump administration and a unified Republican Congress, as well as state-level pharmacy policies that may advance as Republican public policy momentum builds.
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