The US District Court for the Northern District of Texas on June 18, 2025 vacated portions of the HIPAA Privacy Rule to Support Reproductive Health Care Privacy (2024 Final Rule) related to reproductive healthcare privacy. The ruling in the case of Purl, M.D. v. US Department of Health and Human Services granted judgment in favor of the plaintiffs. Notably, the opinion only addressed reproductive healthcare privacy-related aspects of the 2024 Final Rule, and the court severed the provision of the 2024 Final Rule requiring updates to the HIPAA notice of privacy practices requirements relating to confidentiality of substance use disorder health records. That requirement remains intact and becomes effective February 16, 2026.
ML BeneBits
EXAMINING A RANGE OF EMPLOYEE BENEFITS
AND EXECUTIVE COMPENSATION ISSUES
AND EXECUTIVE COMPENSATION ISSUES
President Donald Trump issued an executive order (EO) on May 12, 2025 to address the high cost of prescription drugs in the United States with the goal of ensuring Americans have access to most-favored-nation (MFN) pricing, which aligns drug prices in the United States with those in comparably developed countries.
The US Departments of Health and Human Services, Labor, and the Treasury (together, the Departments) filed a motion to suspend the litigation proceedings in The ERISA Industry Committee vs. HHS et al. on May 9, 2025 while the government reconsiders final regulations implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). On May 12, the US District Court for the District of Columbia granted the stay.
Since taking office, President Donald Trump has issued several executive orders (EOs) and actions that may have an impact on group health plans. These EOs provide insight into the US administration’s policies and outline potential actions that regulatory agencies and Congress may take to implement these policies.
A growing number of class action lawsuits have been filed against employer-sponsored self-insured group health plans alleging that tobacco cessation wellness programs violate key provisions of the Employee Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA). These lawsuits challenge tobacco cessation programs on the grounds that they do not comply with the HIPAA nondiscrimination rules and ERISA’s fiduciary duties. As litigation on this issue continues to evolve, plan sponsors may consider proactive steps to ensure their tobacco cessation wellness programs comply with legal requirements to mitigate potential litigation risks.
Each year, employers that provide prescription drug coverage to Medicare-eligible individuals through a group health plan must complete a two-step process regarding the prescription drug coverage they offer to active employees and their eligible dependents. The deadline for one of those required steps is fast approaching.
On December 23, 2024, President Biden signed into law two bills that will simplify employer reporting compliance under the Affordable Care Act (ACA). The new laws streamline the rules for employers furnishing ACA reporting forms to covered individuals.
The use of artificial intelligence (AI) in the administration of group health plans is nothing new: AI has been used for a number of years to analyze data, improve risk assessment, identify fraud, and streamline claims administration. AI can automatically review and approve or deny claims based on medical codes, reducing manual processing time with the goal of improving efficiency and accuracy in claims adjudication. In some cases, plan sponsors are making AI tools that provide plan participants with personalized healthcare recommendations available at enrollment, identifying, for example, which of the plan sponsor’s benefit options is the best choice for the plan participant and any dependents.
The US Department of Health and Human Services’ (HHS) final rule on reproductive healthcare privacy is already subject to challenge even before its effective date. As described in our previous blog post, the HHS issued final rules amending the HIPAA Privacy Rule, with the intention of enhancing safeguards surrounding the use and disclosure of protected health information in the context of reproductive healthcare. Covered entities must comply with certain provisions of the final rule by December 23, 2024.
The Inflation Reduction Act (IRA) made several changes to Medicare Part D that may impact whether employer-sponsored coverage will be creditable for the 2025 plan year. With open enrollment season about to begin, plan sponsors that provide prescription drug coverage to Medicare-eligible individuals should double check their plan’s creditable coverage status for 2025.