December provided employers an opportunity to review year-end compliance to prepare for the new year. Employers confirmed that their worksite posters are appropriate for the type of business, number of employees, and state, and are the most recent version. Employers who are applicable large employers (ALEs) must be aware of potential penalties including those for not offering affordable coverage through employer contributions. Several states have implemented their own Individual Mandate, consequently employers in those states need to prepare for the type and timing of that reporting. December was also a good time to review retention and confidentiality requirements for employee files and employment-related records pertaining to group benefits.

November brought an FAQ from the Departments of Labor, Health and Human Services, and the Treasury ensuring that SBCs and claims and appeals notices are available when more than 10 percent of the population is literate only in a specific non-English language. UnitedHealth’s pharmacy benefit manager announced $35 insulin price caps, while BlueCross BlueShield continues moving into direct-care delivery. California takes a step toward a single-payer system, while Chicago introduced a paid leave and paid sick and safe leave ordinance.

October saw the release of adjusted civil penalties for HIPAA violations, ACA requirements, and Medicare Secondary Payer rules. Health plan limits and maximums for 2024 including high deductible health plans (HDHPs), health savings accounts (HSAs) flexible spending accounts (FSAs), and dependent care FSAs have been announced. Minnesota enacted a Paid Sick and Safe Leave Law to take effect on January 1, 2024, and California expanded its Paid Sick Leave. The IRS announced the annually adjusted Patient-Centered Outcomes Research Institute (PCORI) fee.

In September, plan sponsors began sending out Medicare Part D Creditable Coverage notices, and both Oregon and Maine announced Paid Family and Medical Leave laws. Sponsors of group health plans began completing the required Gag Clause Attestation due by the end of 2023. The Departments of Labor, Health and Human Services, and Treasury released guidance on complying with the MHPAEA, and are soliciting comments on ways to motivate participation by TPAs. The government once again offers free COVID-19 tests with home delivery.

In August, the IRS announced a decrease in the ACA affordability percentage to 8.39%. Both Colorado and Illinois expanded their leave laws. The Department of Labor released its updated version of the Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Notice. Employers prepared for the possibility of receiving a medical loss ratio rebate from their carrier and President Biden issued a Proclamation announcing Overdose Awareness Week, making it easier for doctors to prescribe effective treatments for addiction.

July saw two proposed rules, one focusing on short-term, limited-duration health plans, and one addressing provider networks and data collection for the Mental Health Parity and Addiction Equity Act (MHPAEA). The PCORI fee was due on July 31 for plan sponsors of self-insured groups and HRAs. President Biden encourages group health plan sponsors to extend the open enrollment period for employees coming off Medicaid and CHIP.

June was preparation time for employers with self-funded plans and HRAs. The Patient-Centered Outcomes Research Institute (PCORI) fee will be due for those plans on July 31. Self-insured non-federal governmental health plans can no longer opt out of the MHPAEA, and COVID-19 Form I-9 flexibilities are ending.

May brought a reminder memo from the IRS on claims substantiation and payment of medical and dependent care expenses, and an update for the 2024 HDHPs, HSAs, and Excepted Benefit HRA limits. The Departments of Labor, Health and Human Services, and the Treasury issued an FAQ on the Braidwood decision, which concluded that the determination of certain preventive care requirements under the Affordable Care Act violated the Appointments Clause of the United States Constitution.

While the compliance focus for April continues to be on the Prescription Drug Data Collection (RxDC) of the Consolidated Appropriations Act, 2021, the Centers for Medicare and Medicaid Services (CMS) released a Fact Sheet announcing the 2024 benefit parameters for Medicare Part D.

After a slow start to the year in compliance, March ramped up with FAQs from the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Internal Revenue Service (IRS) (the “Agencies”) on the gag clause provision of the Consolidated Appropriations Act (CAA), including how to submit the required annual attestation. Additional FAQs were provided by the IRS on paying or reimbursing nutrition, wellness, and general health expenses from a health flexible spending arrangement (FSA), health reimbursement arrangement (HRA), or health savings account (HSA).