HR Tips: COVID-19 policies, CMS monitoring begins, MHPAEA final rule

Tips for the cold, flu, and COVID season

Many employers have not updated their COVID-19 policies since the height of the pandemic and stale policies that rely on outdated guidance could disrupt business continuity. Stay abreast of CDC updates, and decide what health and safety protocols should be continued to limit the spread of infectious disease, such as enhanced cleaning protocols, hand sanitizers, and providing disposable face masks for employees who wish to wear them. Also, encourage employees to stay home when they are showing symptoms of respiratory disease and encourage remote work if your business allows it.

CMS to begin monitoring for late TCOR and ORM

This month, the Centers for Medicare & Medicaid Services (CMS) will begin monitoring for late TPOC (total payment obligation to claimant) and late reporting of On-Going Responsibility for Reporting "ORM" for entities that report Workers' Compensation, Liability, and No-Fault claims. While the process of randomly selecting claims for review and penalty notifications will begin in October 2025, the 365-day "compliance clock" started on October 11, 2024. This means every reportable Medicare Secondary Payer (MSP) occurrence that occurs on or after October 11, 2024, is eligible for review of compliance. Compliance with reporting obligations is defined by the rule as the successful submission and acceptance of the report of NGHP coverage, acceptance of ORM, or TPOC. More information.

Final rules under the Mental Health Parity and Addiction Equity Act

On September 9, 2024, the U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury released new final rules implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). The focus of the changes is implementing the nonquantitative treatment limitation ("NQTL") comparative analyses requirements in accordance with the amendments made to the law in 2021.

The requirements prohibit group health plans and health insurance issuers from using NQTLs that place greater restrictions on access to mental health and substance use disorder benefits as compared to medical and surgical benefits. The data evaluation requirements are greatly expanded and more complex. Even if the rule is challenged, the NQTL analysis is a statutory requirement enacted under the CAA and that requirement is not going away. Employers will need to work with their TPAs, network administrators, PBMs, and other service providers to ensure an NQTL analysis will meet DOL standards. The DOL provides a useful list of warning signs for common noncompliance items relating to a group health plan's NQTLs. Plans have a tight response timeframe for providing the NQTL analysis (DOL - 10 business days, participant - 30 days), so you cannot wait to prepare an NQTL analysis until a participant or the DOL asks.

It's important to review existing contracts and to negotiate new or renewed contracts to ensure a contractual commitment to perform (or, at a minimum, assist with) the NQTL comparative analysis. Effective Jan. 1, 2025, a named fiduciary must certify that they prudently selected and monitored the service provider(s) that performed the comparative analysis.

The final rules generally apply to group health plans beginning on the first day of the plan year beginning on or after January 1, 2025. However, the standards for meaningful benefits, prohibition on discriminatory factors, and data evaluation requirements will take effect on the first day of the plan year beginning on or after January 1, 2026.