NFP's Insights from the Experts

In this episode, Chase Cannon and Suzanne Spradley explain how health-contingent wellness programs work under HIPAA. The two outline new DOL FAQs that state that the DOL won't take enforcement action against plans that apply a wellness program reward only prospectively from the alternative standard completion date. Chase highlights the reasons why temporary enforcement relief doesn't stop private lawsuits, while the two wind the podcast down discussing certain disclosure requirements and practical steps employers can take to line up their plan language, communications, and administration.

In this episode, Suzanne Spradley and Chase Cannon explore the growing interest in value-based pricing models for health plans, including bundled payments, capitation, and outcome-based arrangements. The two discuss how these models aim to connect payment with quality and cost outcomes, while highlighting the ERISA fiduciary, contracting, PBM transparency, HIPAA, and plan document considerations that sponsors should evaluate before adopting them. Listeners will come away with a practical understanding of both the promise and the compliance challenges of moving beyond traditional fee-for-service arrangements.

In this episode, Suzanne Spradley and Chase Cannon discuss the rise of value-based care (VBC) arrangements and break down the compliance considerations employers should consider when implementing them. Suzanne begins with a description of ERISA’s fiduciary obligations as they relate to VBC arrangements. Chase and Suzanne then discuss how a fiduciary checklist can assist with those obligations, as well as the other compliance rules that need to be reviewed in connection with VBC arrangements.

In this episode, Chase Cannon and Suzanne Spradley discuss the Department of Labor’s proposed new electronic disclosure safe harbor for ERISA group health plans. Chase begins with some background on the current DOL electronic disclosure rules. Then, the two discuss how the proposal could modernize the delivery of required health plan notices, reduce reliance on paper disclosures, and give employers a new notice-and-access option while preserving important participant protections. They also cover practical considerations for employers, including covered documents, website requirements, bounced electronic notices, privacy concerns, and what the final rule might look like.

In this episode, Suzanne Spradley and Chase Cannon discuss the usage of artificial intelligence (AI) in plan-related administrative tasks. Suzanne begins with an outline of how carriers, vendors, TPAs, and employers as plan sponsors are currently using AI. Suzanne and Chase discuss the impact AI might have on an employer plan sponsor’s ERISA fiduciary obligations, including the duties of prudence, loyalty, and monitoring, particularly in the context of adverse benefit determinations. The two close with a discussion on AI’s impact on other compliance laws, including HIPAA and the mental health parity rules.

In this episode, Chase Cannon and Suzanne Spradley discuss a recent HHS Office for Civil Rights settlement showing that self-insured employer-sponsored group health plans are not outside the reach of HIPAA enforcement — especially when ransomware, electronic PHI, and incomplete risk analysis are involved.

In this episode, Suzanne Spradley and Chase Cannon revisit the history and importance of the tax exclusion for employer-sponsored insurance (ESI) coverage. Suzanne takes us back to the 1940s to understand how the tax exclusion began. The two discuss the reasons for the longevity and stability of the ESI model and how it has impacted the accessibility and affordability of health insurance in the U.S. Suzanne closes by addressing a new U.S. Congressional proposal that could impact employers and the ESI model.

In this episode, Chase Cannon and Suzanne Spradley look at some common blind spots that employers, as plan sponsors, should review with respect to compliance. Chase outlines the first two blind spots that relate to the application of COBRA and COBRA initial notice distribution. Chase and Suzanne then discuss how employee counts can trip up employers when it comes to how certain compliance laws apply. The two close the podcast with a discussion of the impact of remote employees on state paid family and medical leave requirements.

In this episode, Suzanne Spradley and Chase Cannon discuss two recent circuit court decisions and their impact on employer-sponsored group health plans. Suzanne first discusses a Sixth Circuit decision involving a state law that attempts to regulate PBMs. Suzanne and Chase walk through Supreme Court precedent that appears to be driving states to enact PBM laws, and they explain how ERISA preemption is at the heart of it all. Suzanne concludes the podcast by outlining another federal decision relating to a fiduciary breach claim of an employer group health plan.

In this episode, Chase Cannon and Suzanne Spradley review three important upcoming compliance-related deadlines. Chase highlights the three requirements, including ACA reporting, an April 15 deadline related to HSA contributions and distributions, and RxDC reporting. Chase and Suzanne discuss some practical approaches to each of those deadlines and conclude with a summary of how recent DOL enforcement priorities and ERISA fiduciary litigation come into play.