Compliance Matters Newsletter | May 2026

Let our team help you navigate the ever-changing benefits compliance landscape each month. Check out this month’s latest alerts, additional updates, and resources hot off the press:

Employee Benefits Compliance Alerts

This month’s Compliance Matters newsletter provides a comprehensive review of the following topics. To obtain your copy, please use the form below to download.

• The No Surprises Act: Overview and Considerations for Plan Sponsors
• Retroactive Cancellation of Coverage – The ACA “No Rescissions” Rule
• HIPAA Special Enrollment Rights
• States Series: Updates to New Mexico Vaccine Assessment
• Litigation Series: Appellate Court Dismissed GLP-1 Lawsuit

Additional Updates & Resources

Reminder! RxDC Reporting Due June 1

Annual Prescription Drug Data Collection (RxDC) reporting is required by June 1 of each year. Reporting for the data from 2025 will be due June 1, 2026. The reporting consists of a plan file (P2), eight data files (D1 – D8), and accompanying narratives. Most employer-sponsored health plans rely heavily on their carriers, third-party administrators (TPAs), and pharmacy benefit managers (PBMs) to provide the data necessary, and in many cases, to submit the reporting to Centers for Medicare and Medicaid Services (CMS) on behalf of employer group health plans. To complete the reporting, the carrier or TPA may reach out to employers to ask for information about premium splits (employer and employee contributions) as well as other data required for the D1 file. Once this information is provided, the carrier, TPA and/or PBM may handle the entirety of a group health plan’s RxDC reporting, so employers should make sure to timely respond to such requests. If the employer fails to timely respond with the requested data, or if the carrier/TPA/PBM is unwilling to help with the D1 file, the employer may have to submit a P2 and D1 file on their own.

CMS released updated instructions for RxDC reporting in late February. The instructions don’t include any substantive changes. The latest instructions and templates can be found here.

For more information on RxDC reporting, access our Compliance Matters alert from March 2025.

IRS Sample Plan Language – Educational Assistance Programs

The Internal Revenue Service (IRS) has issued Publication 5993, a sample plan document designed to help employers establish a compliant educational assistance program under Section 127 of the Internal Revenue Code. The sample plan provides a framework that satisfies IRS requirements while allowing employers flexibility to customize the language to match their plan offering.

New HIPAA Rule Modernizes Claims Processing

This final rule establishes the first nationwide Health Insurance Portability and Accountability Act (HIPAA) standards for electronically exchanging health care claims attachments such as medical records and clinical data and requires the use of secure electronic signatures for those transactions. It replaces outdated manual processes like faxing and mailing with standardized electronic systems, improving efficiency, speeding claims processing, and enhancing data security across providers and insurers. Overall, the rule modernizes administrative workflows in healthcare and is projected to save the industry roughly $780 million annually while reducing burden and improving care delivery. Compliance, which will be handled primarily by carriers and TPAs on behalf of group health plans, is required by May 26, 2028.

Federal Register: Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures

Sixth Circuit Affirms ERISA Preemption of Tennessee PBM Law

On April 7, 2026, a year following a decision in a lower court, the Sixth District Court of Appeals held in the case McKee Foods Corporation v. BFP Inc., that the Employee Retirement Income Security Act (ERISA) preempts Tennessee’s pharmacy benefit manager (PBM) laws requiring any-willing-provider (AWP) pharmacy network inclusion and prohibiting differential cost-sharing arrangements. For more information and background access our Alert from May 2025.